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Signed by Patient Date Or Signed by Personal Representative On Behalf of DHCS 6247 11/07 Page 1 of 2 IDENTIFYING INFORMATION COPY OF IDENTIFICATION ATTACHED TYPE CA DRIVER S LICENSE CA DMV IDENTIFICATION CARD BIRTH CERTIFICATE BENEFITS IDENTIFICATION CARD MANAGED CARE CARD STATE OR FEDERAL EMPLOYEE ID CARD NUMBER IF NO IDENTIFICATION IS ATTACHED YOUR SIGNATURE MUST BE NOTARIZED.

How to fill out medi cal form 6247

How to fill out dhcs 6247?

1. Gather all required information and documentation needed for completing dhcs 6247 form.
2. Read the instructions carefully to understand the purpose and requirements of the form.
3. Start by providing your personal information such as name, address, and contact details in the appropriate sections of the form.
4. Fill out all the necessary sections and fields accurately and truthfully.
5. Make sure to include any supporting documents or attachments as requested in the form.
6. Review your completed form thoroughly to avoid any errors or missing information.
7. Sign and date the form in the designated area.
8. Submit the filled-out dhcs 6247 form to the appropriate recipient as instructed.

Who needs dhcs 6247?

1. Individuals who are eligible for and require specific healthcare services or benefits from the Department of Health Care Services (DHCS).
2. Patients who are seeking financial assistance or coverage for medical treatments and procedures.
3. Healthcare providers or facilities that need to submit a request for payment or reimbursement for services provided to eligible individuals.
4. Caregivers or guardians responsible for the healthcare needs of eligible individuals who require assistance and support from DHCS.

Video instructions and help with filling out and completing dhcs 6247

Instructions and Help about dhcs 6247 form

Well good afternoon everybody it is 1 o'clock and we just have a little bit of time left together really pleased to welcome DHCS director Jennifer Kent to the stage along with CHCs Chris Peron we're gonna try something a little bit different for this final panel sorry to disappoint some of you but there will not be any PowerPoint and there actually won't be anyone standing up here talking at you what we'll do is we've structured an informal dialogue among the three of us we will have take tot or we will take questions from the audience at the end we'll aim for about 20 or 25 minutes of questions so as we're talking please do take note of any questions that you do have and on that note I'll start the group off with the first question I would direct this first to Jennifer and then to Chris Jennifer could you share with us sort of at a broad level maybe your top three priorities or issues that you think the medical program will need to focus on in the coming one to three years great thanks aside from the goal of just surviving day-to-day sure so as you heard from the previous panels we do a lot of really important work in the department we have a lot of really creative ways that we try to get services to beneficiaries we have a lot of things that we do in partnership with the counties and the legislature and the federal government but on any given day the fact I still continue to be amazed that there are women out there that get pregnant and need maternity services and eventually need to deliver a baby and they do all of that and we somehow pay the hospital and the mom goes home with a baby and everything kind of works out and all is good I'm still fundamentally surprised that we actually managed to do that with the success that we do and then you talk about much more complicated things within the department when you talk about kind of the top three things that I have been either focused on or continue to focus on one of which is making sure that we as a department are always mindful of the fact that we have a lot of people that rely on us for services and so what are we doing on any given day to make sure that we are trying to make our program as either accessible or as functional as possible sometimes it's not all that interesting or headline-grabbing to say that I just want my department to function as a program but that's really actually a really important thing for us is that when we scramble something and believe me we do it it impacts someone at a very personal and real level and so we have tried really hard over the last few years to take a breath enjoy the fact that we have good economic circumstances in that our state has the funding to be able to fully support the program and we're not in a place where we're cutting the budget but really to focus on are we contracting with the right people are we doing the right oversight and monitoring are we making sure that the services that we are delivering down at the at the ground patient level...

People Also Ask about

How do I update my Medi-Cal information?

For Medi-Cal, you must report it within 10 days. To report changes, call Covered California at (800) 300-1506 or sign in to your online account. You can also find a Licensed Insurance Agent, Certified Enrollment Counselor or county eligibility worker who can provide free assistance in your area.

Which requires an authorization to release protected health information?

A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.

How to replace state of California benefits identification card?

​ Helpful Hints & Resources Lost or stolen Medi-Cal Beneficiary Identification Cards (BIC): If you have just lost your BIC card, contact your local county worker for a replacement. The California Medical Board: (800) 430-4263. Medi-Cal Managed Care Ombudsman: (888) 452-8609. Medi-Cal Billing: (800) 541-5555.

What is the authorization for disclosure of information form used for?

A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations. Continue reading to find out what authorization to disclose health information is needed.

What is an example of when authorization is needed for use and disclosure of PHI?

When Must Patient Authorization be Obtained for Uses and Disclosures of PHI? Authorizations are generally required for psychotherapy notes, substance abuse disorder and treatment records, and for marketing purposes.

What is authorization for use and disclosure of protected health information?

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

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What is dhcs 6247?

DHCS 6247 is a form used by the California Department of Health Care Services to collect health-related data for the Medi-Cal program.

Who is required to file dhcs 6247?

Providers participating in the Medi-Cal program are required to file DHCS 6247 to report necessary information related to health services provided.

How to fill out dhcs 6247?

To fill out DHCS 6247, you must provide accurate data regarding patient care, service details, and comply with the guidelines provided by the California Department of Health Care Services.

What is the purpose of dhcs 6247?

The purpose of DHCS 6247 is to ensure accurate tracking and reporting of health services and outcomes for Medi-Cal beneficiaries.

What information must be reported on dhcs 6247?

Information required on DHCS 6247 includes patient demographics, services rendered, diagnosis codes, and billing information.