The non-disclosure of W-I, Section 14043.2 (a) indicates that the non-disclosure of the necessary information or the disclosure of incorrect information has the effect of excluding the application for registration or temporarily suspending the Medi-Cal provider, which implies the temporary deactivation of all vendor numbers used by the supplier to obtain a refund under the Medi Cal program. Finally, in his letter filed at the end of September 2019, the petitioner argues that he “filed an application for subpoena with the ATM to obtain MediCal`s supplier documents on the respondent, but the distributor did not give in to that request for an investigation.” The petitioner is unaware that I rejected his application on September 4, 2019. The petitioner did not make any further requests for subpoena. The Centers for Medicare – Medicaid Services (CMS) was impersonated by an administrator, Noridian Healthcare Solutions (Noridian), who terminated the registration and billing privileges of Timur Pogodins Medicare, M.D. (Petitionary) following the termination of the agreement by the California Department of Health Services and Health Care (DHCS). The petitioner asked to be heard to challenge his dismissal. I confirm the revocation of the petitioner`s registration and the provisions of Medicare. The Medi-Cal Supplier Contract (DHCS 6208) that you have signed and confirmed is: “The supplier undertakes to disclose all information required by Federal Medicaid laws and regulations and all other information requested by DHCS and to respond to all DHCS requests. The supplier also agrees that the supplier`s failure to disclose the necessary information or the disclosure of incorrect information prior to a hearing must lead to the rejection of the registration application or be motivated by the termination of the registration status [sic] or by the suspension of the Medi Cal program, which involves the deactivation of all vendor numbers used by the supplier to obtain a refund under the Medi Cal program.” I called Medicaid. and the employee informed me that my individual registration has not been updated since 03.03.2016 and that Medicaid received a request to update the registration information on 03.07.2017, but that registration failed and was returned on 28.03.2017 with the request for additional information. Complete the DHCS 4468 provider`s registration request and send it by secure email to providerservices@dhcs.ca.gov.

This is the first form in the application process. You will receive the others after it has been approved. Disabling the Family PACT program does not affect medi-cal registration. Deactivated vendors are informed by a letter sent to the address by file. The package of applications is filled only by the supplier. As of November 1, 2018, applications received by external consultants or registration agents on behalf of the applicant to the supplier will not be accepted. For any questions, please contact us at OFPprovidertrainings@dhcs.ca.gov or (916) 650-0414. When transmitting changes to a Medi-Cal data set (service address, NPI, TIN, legal name or company name), vendors must indicate these changes by sending a package of applications to the Family PACT vendor`s registration.