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Provider Enrollment

Welcome to the Medi-Cal Provider Enrollment page and thank you for your interest in becoming a provider in the Medi-Cal program. The Department of Health Care Services (DHCS) Provider Enrollment Division (PED) is responsible for the timely enrollment and re-enrollment of eligible fee-for-service health care providers in the Medi-Cal program.

With the implementation of the Provider Application and Validation for Enrollment (PAVE) Provider Portal, PED now offers an improved web-based enrollment process. PAVE improves access to services, facilitates ease of use and adds efficiencies to enrollment processes. PAVE has been implemented in a series of releases to include additional provider types and enrollment actions. To learn more about PAVE and view the list of provider types eligible to use PAVE, visit the Provider Application and Validation for Enrollment page on the DHCS website.

PAVE Provider Portal

PAVE is a secure, web-based Provider Portal that simplifies and accelerates enrollment processes, including completion and submission of new enrollment applications (Medi-Cal Provider e-Form Application [e-Form]), reporting changes to existing enrollments and responding to PED-initiated requests for re-enrollment or revalidation. PAVE offers intuitive guidance, social collaboration and many other user-friendly features.

Access PAVE

Applicant Instructions & Requirements

Applicant Information by Provider Type (Alphabetical Order)

Applicant Information by Provider Type (Alphabetical Order)

Enrollment Instructions and Requirements

Statutes, Regulations, Moratoria and Bulletins

The criteria for enrollment as a provider in the Medi-Cal program are described in Title 22 of the California Code of Regulations (CCR). Senate Bill (SB) 857 (statutes of 2003), effective January 1, 2004, revised the responsibilities of providers and provider applicants in the Medi-Cal program. Links to documents describing statutes and regulations are as follows:

Statutes and Regulations

2021 – 2022 Certification of Compliance (MC 0805) – Employee education on false claims recovery
Federal Deficit Reduction Act 2005: Employee Education on False Claims Recovery – Published in the December 2006 Medi-Cal Update
California Welfare and Institutions Code (W&I Code), Section 14043 – Includes Senate Bill 857 changes
Provider Enrollment Regulations (California Code of Regulations, Title 22) – Effective August 17, 2015
Suspension of Entities Submitting Claims for Suspended Providers
Provider Enrollment Regulations (California Code of Regulations, Title 22) – Effective July 1, 2008, with section 51240 amended June 16, 2012

Moratoria

There are no provider enrollment moratoria in effect at this time.

Provider Bulletins

Discontinuation of COVID-19 Emergency Fee-For-Service Medi-Cal Enrollment – Effective March 29, 2023, DHCS is discontinuing the provider enrollment flexibilities authorized by the Section 1135 waiver. This bulletin supersedes the bulletin titled “Requirements and Procedures for Emergency Medi-Cal Provider Enrollment.”
Requirements and Procedures for the Medi-Cal Enrollment of Providers Offering Services Remotely or Indirectly from their Business Address – Effective March 29, 2023, this bulletin establishes exemptions to certain established place of business requirements for mental health remote services providers, including NSMHS and SMHS, and transportation providers offering NMT and NEMT services.
Medi-Cal Enrollment Requirements and Procedures for Doulas – Effective January 1, 2023, doula providers may apply for enrollment in the Medi-Cal fee-for-service program by submitting an electronic application through the Provider Application and Validation for Enrollment (PAVE) online enrollment portal.
Updated Requirements and Procedures for the Enrollment of Medi-Cal Dental Providers – Effective October 31, 2022, the Department of Health Care Services establishes new Medi-Cal provider enrollment requirements for dental providers.
Medi-Cal Benefit Updated: Non-Medical Transportation – Effective June 27, 2022, this updated bulletin supersedes the bulletin titled “Medi-Cal Benefit Added: Non-Medical Transportation” and establishes new requirements and procedures for the enrollment of transportation network companies as non-medical transportation providers.
Requirements and Procedures for Reporting of Intermittent Clinics and Mobile Health Units – Informational bulletin detailing the requirements and procedures to report Intermittent Clinics and Mobile Health Units as required pursuant to Welfare & Institutions Code Section 14043.15(e).
Updated Designation of Categorical Risk Level for LA County Pharmacies – Effective May 5, 2022, the Department of Healthcare Services (DHCS) shall designate and screen Medi-Cal fee-for-service pharmacy applicants located in the Los Angeles County as “limited” categorical risk. This regulatory provider bulletin supersedes the bulletin titled, “Designation of Categorical Risk Levels for Pharmacy Providers in Los Angeles County,” published on November 16, 2016, on the DHCS website.
Designation of Categorical Risk Levels for the Drug Medi-Cal (DMC) Program’s Narcotic Treatment Programs (NTPs) and Heroin Detoxification Programs (HDPs) – Effective April 10, 2022, Drug Medi-Cal Program’s offering Narcotic Treatment Program or Heroin Detoxification Program service modalities will be screened at the “high” or “moderate” categorical risk level.
Updated Medi-Cal Enrollment Requirements and Procedures for Diabetes Prevention Programs – Effective February 4, 2022, pharmacies may submit a Supplemental Form in PAVE to add DPP Services to their enrollment in the fee-for-service Medi-Cal program.
Exempt from Licensure FQHCs Reporting a Change of Location or Ownership – Pursuant to California Code of Regulations (CCR), Title 22, Sections 51000.30(a) and 51000.30(b) providers are required to report a change of location and 50 percent or more change in ownership, by submitting a complete application package.
Updated Designation of Categorical Risk Levels for LA County Pharmacies – Effective April 29, 2020, until EO N-55-20 is lifted, the Department of Health Care Services (DHCS) has changed the categorical risk level for any pharmacy provider applicant located in Los Angeles County from “high” to “limited” for the remainder of the national emergency.
Requirements and Procedures for Emergency Medi-Cal Provider Enrollment – Effective March 23, 2020 with a retroactive effective date of March 1, 2020, the Department of Health Care Services (DHCS) has implemented enrollment requirements and procedures for providers seeking enrollment in the fee-for-service Medi-Cal program in response to the national COVID-19 public health emergency.
Updated Medi-Cal Enrollment Requirements and Procedures for Certified Mastectomy Fitters – The Department of Health Care Services (DHCS) is establishing Medi-Cal provider enrollment requirements for Certified Mastectomy Fitters (CMF).
Updated Medi-Cal Enrollment Requirements and Procedures for Diabetes Prevention Programs – The Department of Health Care Services (DHCS) is establishing Medi-Cal provider enrollment requirements for Diabetes Prevention Programs (DPPs).
Medi-Cal Benefit Added: Non-Medical Transportation – Pursuant to Welfare and Institutions Code (W&I Code), Section 14132(ad)(1), non-medical transportation (NMT) is covered, subject to utilization controls and permissible time and distance standards.
Updated Designation of Categorical Risk Levels for the Drug Medi-Cal (DMC) Program – Effective June 13, 2019, the Department of Health Care Services (DHCS) has changed the categorical risk level for Drug Medi-Cal (DMC) providers from “high” to “limited” for newly certifying or newly enrolling DMC applicants and DMC providers that submit an application for revalidation in the fee-for-service Medi-Cal program.
Medi-Cal Enrollment Requirements and Procedures for Licensed Professional Clinical Counselors – Effective June 9, 2019, Licensed Professional Clinical Counselor (LPCC) providers may apply for enrollment in the fee-for-service Medi-Cal program.
Informational Bulletin for the Expired Durable Medical Equipment Moratorium – Informational bulletin for Durable Medical Equipment applicants and providers applying for enrollment following the discontinuation of the moratorium for Durable Medical Equipment applicants and providers located outside of California and in Los Angeles, Orange, Riverside, and San Bernardino counties.
Medi-Cal Enrollment Requirements and Procedures for Applicants and Providers Currently Eligible to Use the Provider Application and Validation for Enrollment (PAVE) Medi-Cal Provider e-Form Application (e-Form) – On November 18, 2016, the Department of Health Care Services (DHCS) instituted a web-based Medi-Cal provider enrollment system entitled Provider Application and Validation for Enrollment (PAVE) 2.0 and on September 4, 2018, PAVE 3.0.
Designation of Categorical Risk Levels for Diabetes Prevention Programs – This bulletin designates newly enrolling Diabetes Program (DPP) applicants as “high risk” and re-enrolling or revalidating DPP providers as “moderate risk.”
Informational Bulletin Regarding Disaster Relief for Providers – In response to the fires across three California counties (Butte, Los Angeles and Ventura), the Department of Health and Human Services (HHS) Secretary declared a public health emergency in California on November 13, 2018, and authorized a Section 1135 waiver, effective November 13, 2018.
Informational Bulletin for the Expired Los Angeles County Pharmacy Moratorium – This informational bulletin is for Los Angeles County pharmacy applicants and providers applying for enrollment following the discontinuation of the Los Angeles County pharmacy moratorium.
Release 3.0 Provider Types Eligible for Provider Application and Validation for Enrollment (PAVE) –This bulletin expands the implementation of the Provider Application and Validation for Enrollment (PAVE) – Web-based Provider Application for Enrollment in the Medi-Cal Fee-for-Service Program to include additional provider types.
Enrollment Effective Date for Ordering/Referring/Prescribing Providers – In accordance with Welfare and Institutions Code (W&I Code), Section 14043.75(b), the Department of Health Care Services (DHCS) issues the following bulletin which establishes a retroactive effective date for ordering, referring or prescribing providers who successfully enroll in Medi-Cal fee-for-service.
Updated Requirements and Procedures for Enrollment as a “Facility-Based Provider” – In accordance with Welfare and Institutions Code (W&I Code), Section 14043.75(b), the Department of Health Care Services (DHCS) issues the following revision of the “Requirements and Procedures for Enrollment as a ‘Facility-Based Provider’” bulletin, posted in February 2005.
Informational Bulletin Regarding Disaster Relief Providers – In response to the fires across nine California counties, the Health and Human Services (HHS) Acting Secretary declared a public health emergency in California on October 15, 2017, and authorized a Section 1135 waiver, retroactive to October 10, 2017.
Informational Bulletin Regarding Acceptable Clinical Laboratory Improvement Amendment Certificates – A CLIA certificate is required by the Department of Health Care Services Provider Enrollment Division to allow clinical laboratories or laboratories to bill for tests that the provider is authorized to perform.
Informational Bulletin Regarding Procedures for Changing the Pay-To and/or Mailing Address of an Institutional Provider – This informational bulletin changes the procedures for institutional providers who wish to update their mailing or pay-to address with DHCS.
Informational Bulletin Regarding Enrollment of Out-of-State Rendering Providers and Clinical Laboratory Providers – DHCS will allow rendering providers and clinical laboratory providers who are located out-of-state to submit applications for enrollment.
Requirements and Procedures to Report Affiliations Between Rendering Providers and Provider Groups – This bulletin amends the initial bulletin titled "Requirements and Procedures to Report Affiliations Between Rendering Providers and Provider Groups" published on October 5, 2016.
Requirements and Procedures for Medi-Cal Provider Groups Designating Delegated Officials for the Sole Purpose of Signing Affiliation Forms – This bulletin establishes requirements and procedures for enrolled and newly enrolling provider groups who wish to assign signatory authority to an employee or employees other than authorized official(s) for the sole purpose of reporting affiliations and disaffiliations either through the Provider Application and Validation for Enrollment (PAVE) electronic form (e-Form) or the Medi-Cal Rendering Provider/Group Affiliation/Disaffiliation Form (DHCS 4029) only.
Designation of Categorical Risk Levels for Pharmacy Providers in Los Angeles County – This bulletin designates newly enrolling pharmacy applicants and revalidating pharmacy providers in Los Angeles as high risk, with the exception of those operated by governmental entities, chain pharmacies and non-profit corporations, and those operated by a Federally Qualified Health Center (FQHC).
Revised Drug Medi-Cal Application and Medi-Cal Supplemental Changes Form – In accordance with the authority granted to the Director of the Department of Health Care Services (DHCS) by Welfare and Institutions Code (W&I Code), Section 14043.75(b), the Director has established the revised application form requirements, set forth below, that must be followed by providers who apply to the Medi-Cal program to be reimbursed.
Requirements and Procedures to Report Affiliations Between Rendering Providers and Provider Groups – This provider bulletin establishes requirements for the reporting of any affiliation between a rendering provider or Non-Physician Medical Practitioner (NMP) and the Medi-Cal provider group (enrolled or newly enrolling) billing for their services.
Provider Application and Validation for Enrollment (PAVE) – Web-based Provider Application for Enrollment in the Medi-Cal Fee-for-Service Program – DHCS is instituting PAVE for the provider types included within this bulletin.
Updated Medi-Cal Non-Emergency Medical Transportation Provider Requirements – In accordance with Welfare and Institutions Code (W&I Code), Section 14043.75(b), the Department of Health Care Services (DHCS) has revised the application requirements for non-emergency medical transportation providers. These requirements implement W&I Code, Sections 14043.15 and 14043.26.
Informational Bulletin Regarding Medi-Cal Requirement to Submit Fingerprints for a Criminal Background Check – This bulletin amends the initial bulletin regarding Medi-Cal Requirements to Submit Fingerprints for a Criminal Background check on September 11, 2015.
Medi-Cal Screening Level Requirements for Compliance with 42 Code of Federal Regulations Section 455.450 – (Reference to 42 CFR Section 455.434 on page 2 has been corrected to 424.518.) In accordance with the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) is implementing Medi-Cal screening level requirements to comply with 42 Code of Federal Regulations (CFR) Section 455.450 and California Welfare and Institutions Code (W&I Code), Section 14043.38.
Informational Bulletin Regarding Medi-Cal Application Fee for Governmental Agencies – Informational bulletin on alternate method of payment for governmental entities applying for enrollment in the fee-for-service portion of the Medi-Cal program.
Medi-Cal Requirements and Procedures for Enrolled Group Providers Requesting to Add a Provider Type – Effective April 3, 2016, enrolled Medi-Cal fee-for-service group providers requesting to add a provider type to an enrolled location will be required to submit a Medi-Cal Supplemental Changes (DHCS 6209) form.
Updated Form: Medi-Cal Provider Group Application (DHCS 6203) – Effective April 3, 2016, the Medi-Cal Provider Group Application (DHCS 6203) will no longer contain references to the application fee.
Informational Bulletin Regarding Medi-Cal Revalidation Requirement – DHCS will send out notification of the revalidation process to each provider. Providers must wait to submit the revalidation until asked by DHCS to do so.
Medi-Cal Enrollment Requirements and Procedures for Licensed Midwives – Effective March 2, 2016, the Department of Health Care Services will accept applications to enroll licensed midwives as direct billers.
Application of Health and Safety Code Section 1206 to Medi-Cal Fee-for-Service Provider Enrollment – Informational bulletin regarding the enrollment of clinics exempt from licensure.
Informational Bulletin Regarding Medi-Cal Application Fee Requirements – This informational bulletin supplements the initial bulletin, titled "Medi-Cal Application Fee Requirements for Compliance with 42 Code of Federal Regulations Section 455.460," posted November 30, 2012.
Requirements and Procedures for Enrollment as a Substance Use Disorder Clinic Located on a School Site – Informational bulletin about exemptions to regulations and implementations of specific enrollment procedures for a Drug Medi-Cal (DMC) applicant or provider, to enroll as a "Substance Use Disorder Clinic Located on a School Site" (School Site Clinic).
Discontinuation of the Moratorium on the Enrollment of Clinical Laboratory Providers – Informational bulletin for clinical laboratory applicants and providers applying for enrollment following the discontinuation of the clinical lab moratorium.
Stakeholder Electronic Notification System – Informational bulletin on subscribing to e-mail service (ListServ) for updates on Drug Medi-Cal (DMC), Fee-for-Service (FFS) Medi-Cal, and PAVE.
Provisions of the Drug Medi-Cal Regulation – Informational bulletin summarizing the emergency changes made to the California Code of Regulations, Title 22 effective August 17, 2015, pertaining to the Drug Medi-Cal program.
Department of Health Care Services Proposed Implementation Plan for Certification/Continued Certification of Providers Under Proposed Drug Medi-Cal Organized Delivery System Waiver – In November 2014, the Department of Health Care Services (DHCS) submitted to the federal Centers for Medicare & Medicaid Services (CMS) a proposed waiver for Drug Medi-Cal Organized Delivery System ("waiver").
Updated Disclosure Statement and Rendering Provider Application/Disclosure Forms – In accordance with Welfare and Institutions Code (W&I Code), Section 14043.75(b), the Department of Health Care Services (DHCS) has established revised application form requirements.
Provision that Allows an Applicant or Provider to Request to Withdraw an Application – On September 18, 2014, California Senate Bill 1465, which allows for an applicant or provider to request to withdraw an application for enrollment or continuing enrollment (Application) under certain conditions, became effective as state law.
Medi-Cal Specific Request for Live Scan Service Now Available
Drug Medi-Cal Provider Agreement Now Available
Medi-Cal Enrollment Requirements and Procedures for Licensed Clinical Social Workers and Licensed Marriage and Family Therapists – Effective November 3, 2014, Licensed Clinical Social Workers and Licensed Marriage and Family Therapist providers may apply for enrollment in the fee-for-service Medi-Cal program.
Medi-Cal Requirement for the Drug Medi-Cal Provider Agreement – Effective October 24, 2014.
Medi-Cal Requirement to Submit Fingerprints for a Criminal Background Check – Effective October 11, 2014, any time an application is submitted to DHCS by a Medi-Cal provider or applicant categorized as "High risk," that provider or applicant must submit proof that fingerprints for all the required individuals have been submitted to an authorized State Identification Bureau (Bureau of Criminal Information and Analysis, Department of Justice [DOJ] in California).
Designation of Categorical Risk Levels for the Drug Medi-Cal (DMC) Program – Effective September 22, 2014, the Department of Health Care Services (DHCS) is required to screen at the high categorical risk level all Drug Medi-Cal Treatment Program providers participating in the Medi-Cal program.
New Versions of Medi-Cal Disclosure Statement and Application Forms for Rendering Providers and Ordering/Referring/Prescribing Providers – Effective July 7, 2014, the Department of Health Care Services (DHCS) is revising the Medi-Cal Disclosure Statement (DHCS 6207), the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216) and the Medi-Cal Ordering/Referring/Prescribing Provider Application/Agreement/Disclosure Statement For Physician and Non-Physician Practitioners (DHCS 6219) to require applicants completing these forms to disclose their social security number.
Updated Applications Required for Durable Medical Equipment Providers – Effective May 1, 2014, the Department of Health Care Services (DHCS) is revising the Medi-Cal Pharmacy Provider Application (DHCS 6205) and the Medi-Cal Durable Medical Equipment Provider Application (DHCS 6201) to include detailed lists of business activities.
Continued Certification for Drug Medi-Cal Providers – Informational bulletin on the continued statewide certification process for all certified Drug Medi-Cal providers.
Medi-Cal Requirement to Report Provider Enrollment Terminations – In accordance with Section 1902(kk)(6) of the Social Security Act and in accordance with 42 Code of Federal Regulations (CFR) Section 455.416(c) published on February 2, 2011, in the Federal Register to implement the Patient Protection and Affordable Care Act (ACA) of 2010, the director of California's Department of Health Care Services (DHCS) is issuing this informational provider bulletin.
Provisions of the Affordable Care Act Create New Medi-Cal Provider Application Screening and Enrollment Requirements – On January 1, 2013, California Senate Bill 1529, which implements sections of the Affordable Care Act of 2010 that pertain to Medicaid provider screening and fraud prevention, becomes effective as state law.
Medi-Cal Requirement for Ordering/Referring/Prescribing Providers Forms and Procedures – In accordance with the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) is establishing the requirement for the Medi-Cal program to enroll ordering, referring or prescribing only providers in accordance with 42 Code of Federal Regulations (CFR) Section 455.410 and 42 CFR Section 455.440.
Medi-Cal Application Fee Requirements for Compliance with 42 Code of Federal Regulations Section 455.460 – In accordance with the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) is establishing the Medi-Cal application fee requirements to implement 42 Code of Federal Regulations (CFR) Section 455.460.
Revised Medi-Cal Provider Disclosure Requirements for Compliance with 42 Code of Federal Regulations – Effective November 15, 2011, in accordance with Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising provider disclosure statements and provider agreements.
Crossover Only Providers Approval for Reimbursement – Effective immediately, a new form is available for use by Crossover Only providers who are seeking reimbursement for services rendered to dual-eligible beneficiaries. This form is to be used solely for approval for reimbursement by Crossover Only providers and not for general Medi-Cal enrollment.
Requirements and Procedures for 'Clinic-Based Certified Nurse Midwife' Enrollment – This bulletin provides a supplement to the current enrollment requirements of the Medi-Cal program for certified nurse midwives.
AB 1226 – Physician Forms & Provisions Effective July 1, 2008 – Effective for dates of service on or after July 1, 2008, Welfare and Institutions Code (W&I Code), Section 14043.26(b) and (e) allow doctors of medicine and osteopathic physicians who meet specified criteria, and who change their business locations within the same county, to use a "change of location" form.
Provider Enrollment Application Changes Due to NPI – Effective February 15, 2008, in accordance with Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising all provider enrollment application forms to accommodate the National Provider Identifier (NPI).
Assembly Bill 1226 – Provisions Affect All Providers – Effective for dates of service on or after January 1, 2008, Assembly Bill (AB) 1226 has two provisions, that affect all providers, and that amend the laws the Department of Health Care Services (DHCS) uses to review provider applications for participation in the Medi-Cal program.
Important Reminder: Providers Selling or Purchasing a Business – As introduced in regulation package R-04-04E, the Department of Health Care Services (DHCS) wishes to remind providers of the ability to accept successor liability with joint and several liability requirements.
Revised Application Form Requirements, Procedures Due to NPI Implementation – Effective May 23, 2007, applicants and providers will be required to submit their National Provider Identifier (NPI) with each Medi-Cal provider application package.
New Versions of Provider Applications and Disclosure Forms – All required provider application and disclosure forms have been revised to comply with the disclosure requirements of California Code of Regulations (CCR), Title 22, Sections 51000.30, 51000.31, 51000.32, 51000.35 and 51000.40. Published in the March 2006 Medi-Cal Update.
Changes to Rendering Provider Enrollment Process – Effective immediately, rendering providers within provider groups no longer need to re-enroll for every group and location where they practice. Published in the December 2005 Medi-Cal Update.
Requirements and Procedures for 'Clinic-Based Provider' Enrollment – Intended to provide a supplement to the enrollment requirements currently applicable to physicians who are solely employed by or provide services pursuant to a contract with licensed primary care clinics, except for services provided as part of a graduate medical education program, and who do not have any active Medi-Cal provider numbers issued to them individually to bill for clinical services to Medi-Cal beneficiaries at another location. Published in the December 2005 Medi-Cal Update.
Requirements and Procedures for Successor Liability – Pursuant to the California Code of Regulations (CCR), Title 22, Sections 51000.20.1, 51000.24.1, 51000.25.2, 51000.32 as introduced in regulation package R-04-04E, the Department of Health Care Services (DHCS) is introducing the ability for providers to accept successor liability with joint and several liability requirements. Published in the December 2005 Medi-Cal Update.
Effective Date of Enrollment – How DHCS determines "the date on the notice" when granting provisional or preferred provisional provider status under the Welfare and Institutions Code (W&I Code), Section 14043.26 and an exception for contractors for hospital-based services for emergency care. Published in the June 2004 Medi-Cal Update.
Preferred Provider Status – How physicians can request, and provide documentation and verification for, consideration for enrollment in the Medi-Cal program as a Preferred Provisional Provider. Published in the February 2004 Medi-Cal Update.

Resources

For current application fee information, please see the Current Application Fee document on the DHCS website. The Centers for Medicare & Medicaid Services has announced a change in the provider Application Fee for Calendar Year 2019.

Medi-Cal Provider Application Fees

Medi-Cal Provider Application Fees

Preferred Provider Status

Current Information on Preferred Provider Status

Returned Warrants

The provider number(s) used by a provider are subject to deactivation when warrants or documents mailed to a provider's mailing address, pay-to address, if any, or its service or business address, are returned by the U.S. Postal Service as not deliverable (W&I Code § 14043.62). Changes in address are to be reported to the Department of Health Care Services (DHCS) within 35 days of the change (22 CCR § 51000.40). Upon notification from DHCS that the address has been updated, the provider may request payments be re-issued by submitting a written request to the California MMIS Fiscal Intermediary for Medi-Cal, at the following address:

California MMIS Fiscal Intermediary
c/o Cash Control Unit
P.O. Box 13029
Sacramento, CA 95813-4029

You must include your provider number, warrant number, date issued, and the amount of the warrant on the letter. The FI will re-issue warrants to the pay-to address listed on the Provider Master File (PMF).

Contact DHCS Provider Enrollment Division

Suspended and Ineligible Provider List

Suspended and Ineligible Provider List

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