Mandatory SSN Now Required for Medi-Cal Provider Applicants


In accordance with the Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising the Medi-Cal Ordering/Referring/Prescribing Provider Application/Agreement/Disclosure Statement For Physician and Non-Physician Practitioners(DHCS 6219), the Medi-Cal Rendering Provide Application/Disclosure Statement/Agreement For Physician/Allied/Dental Providers (DHCS 6216) and the Medi-Cal Disclosure Statement (DHCS 6207). These revisions are necessary for implementation of the Final Rule published by CMS on February 2, 2011, in Volume 76, Number 22 of the Federal Register (Title 42 Code of Federal Regulations [CFR], Parts 405,424, 447 et al.) and specifically for compliance with 42 CFR, Section 455.104(b), which mandates disclosure of Social Security Numbers (SSNs)

These revisions are also necessary for compliance with 42 CFR , Section 455.436, which mandates that the State Medicaid Agency perform routine checks of Federal databases. The revised forms and SSN requirement will be effective for all Medi-Cal provider applications received on or after July 7, 2014.

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