Licensed Midwife Application Information
Midwives (licensed by the Medical Board of California) are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment). If you are submitting a group application, please ensure you also submit at least two rendering applications in PAVE in order to form your group.
Licensed Midwives can enroll in Medi-Cal as rendering providers in physician groups that specialize in obstetrics.
Licensing
Required Documents
Next, gather the required documents listed below, as applicable, in order to upload them into PAVE as you complete your PAVE application.
Please ensure the uploaded documents are legible.
1.
California Midwife License for applicant; California Medical License of the applicant’s supervising physician and California Medical License of the applicant’s employing provider, if applicable and if different than the supervising physician.
2. Driver’s License or state-issued identification cards (issued within the 50 United States or the District of Columbia) for each of the following;
a. The Licensed Midwife Applicant
b. The Supervising Physician named on the application form
c. The person signing the application for the Employing Provider. If the employing provider is a corporation and the forms are going to be signed by a person other than the employing provider, please submit a copy of the section of the corporation’s bylaws that identifies the signing person’s authority to legally bind the corporation.
3. Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please contact the
IRS at (800) 829-4933.
4.
Certificate of Professional Liability Insurance in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name of the insured, effective dates, and limits of coverage. Note: The provider’s name, as it appears on the California Midwife License, must also show on the verification of the professional liability insurance.
5.
Licensed Midwife’s Verification of Employment
PROCEED TO PAVE
