Form DHCS9096 Medi-Cal Change of Location Form for Individual Physician or Individual Dentist Practices Relocating Within the Same County - California

What Is Form DHCS9096?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHCS9096 form?
A: The DHCS9096 form is the Medi-Cal Change of Location Form for Individual Physician or Individual Dentist Practices Relocating Within the Same County in California.

Q: Who is this form for?
A: This form is for individual physician or individual dentist practices relocating within the same county in California.

Q: What is the purpose of the DHCS9096 form?
A: The purpose of the DHCS9096 form is to notify Medi-Cal of a change in location for an individual physician or individual dentist practice.

Q: When should the DHCS9096 form be filled out?
A: The DHCS9096 form should be filled out when an individual physician or individual dentist practice is relocating within the same county in California.

Q: Is there a fee for submitting the DHCS9096 form?
A: No, there is no fee for submitting the DHCS9096 form.

Q: What information is required on the DHCS9096 form?
A: The DHCS9096 form requires information such as the practice's name, National Provider Identifier (NPI) number, new location address, effective date of the relocation, and contact information.

Q: Are there any supporting documents required with the DHCS9096 form?
A: Yes, supporting documents such as a copy of the lease or rental agreement for the new location may be required when submitting the DHCS9096 form.

Q: How can I submit the DHCS9096 form?
A: The DHCS9096 form can be submitted by mail or fax to the address or fax number provided on the form.

Q: What happens after I submit the DHCS9096 form?
A: After submitting the DHCS9096 form, the California Department of Health Care Services (DHCS) will update the practice's information in the Medi-Cal system.

Q: How long does it take for the DHCS9096 form to be processed?
A: The processing time for the DHCS9096 form may vary, but it is generally processed within a few weeks.

Q: Can I still see patients while my DHCS9096 form is being processed?
A: Yes, you can continue seeing patients at your current location while your DHCS9096 form is being processed.

Q: What should I do if there are changes to my practice's information after submitting the DHCS9096 form?
A: If there are any changes to your practice's information after submitting the DHCS9096 form, you should notify the California Department of Health Care Services (DHCS) as soon as possible.

Q: Is there a deadline for submitting the DHCS9096 form?
A: There is no specific deadline for submitting the DHCS9096 form, but it is recommended to submit the form as soon as possible after the practice relocation.