Forms Mc 6007 And Mc 6008 - Instructions For Completing Dmc Forms For Dcr - Alcohol And Drug

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State of California – Health and Human Services Agency
Department of Health Care Services
INSTRUCTIONS FOR COMPLETING DMC FORMS FOR
DCR – ALCOHOL AND DRUG
(Forms MC 6007 and MC 6008)
The filename for the FY 2011-12 Cost Report Forms is “1112_DP_DCR_AD.xls”. A separate
worksheet has been created for each document within the file. The worksheets are “7895DCR-AD”
and “7990DCR-AD”. Enter data only in the blue-shaded fields on worksheet “7895DCR-AD”, all
other fields are automatically calculated.
WORKSHEET “7895DCR-AD” (MC 6007)
Heading: Enter the County Name, Contractor, Contract Number, 4-digit DMC Provider Number, and
the 6-digit Provider Number.
Cost Information: Enter the specific cost information for the following areas: Private Pay and
Drug Medi-Cal. (Pages 1 and 2)
Unit Information: Enter the specific unit information for the following areas: Private Pay and
Drug Medi-Cal. (Page 1 only)
This worksheet identifies the total funding.
WORKSHEET “7990DCR-AD” (MC 6008)
Line 04a:
For the reporting period (July through June), enter the number of total units
submitted for reimbursement (excluding Minor Consent non-Title XIX claims) and the
number of those units that were denied.
Line 04c4:
For the reporting period (July through June), enter the number of total units
submitted for reimbursement for Non-Title XIX Minor Consent and the number of
those units that were denied. This is only for individuals with 7N aid code.
This worksheet identifies the DMC funding split between Federal and Realignment share.

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