Medi-Cal Providers Medi-Cal Fee-For-Service Provider Support and Services The Medi-Cal Providers website provides access to Medi-Cal billing support services and to perform secure Medi-Cal Fee-for-Service and other associated health care program claims and transactions
Medi-Cal Get help with Medi‑Cal Learn how to apply, see if you qualify, explore your benefits, and find out how to keep your health care coverage
Share of Cost (SOC) - Medi-Cal Some Medi-Cal subscribers (recipients) must pay, or agree to pay, a monthly dollar amount toward their medical expenses before they qualify for Medi-Cal benefits This dollar amount is called Share of Cost (SOC) A Medi-Cal subscriber’s SOC is similar to a private insurance plan’s out-of-pocket deductible
Evaluation Management (E M) (eval) - Medi-Cal Medi-Cal providers may bill for medically necessary palliative care services for eligible Medi-Cal recipients diagnosed with a serious and or life-threatening illness, as determined and documented by the patient’s treating health care provider
Appeal Form Completion (appeal form) - Medi-Cal This section describes the instructions for completing an Appeal Form (90-1) An appeal is the final step in the administrative process and a method for Medi-Cal providers with a dispute to resolve problems related to their claims
Flyer_New_Provider_Checklist - Medi-Cal Welcome, New Providers The Department of Health Care Services (DHCS) thanks you for becoming a Medi-Cal provider and joining California’s network of comprehensive health care programs, which serves about 13 million Californians — forming the backbone of California's health care safety net
Hearing Aids (hear aid) - Medi-Cal Hearing Aid Coverage for Children Program (HACCP) ‹‹Children younger than 21 years of age who are not eligible for Medi-Cal may qualify for state-only coverage of hearing aids and related services through HACCP ›› Providers may refer to the Hearing Aid Coverage for Children Program webpage for additional information about HACCP eligibility, benefits and claim authorization
Other Health Coverage (OHC) Guidelines for Billing (other guide) - Medi-Cal OHC Code C OHC Code “C” identifies Medi-Cal recipients who have OHC through a military benefits health care plan Providers under military benefits health care plans (for example, Tricare, Veteran’s Affair, or CHAMPVA) should treat the recipient ‹‹If not a contracted provider of the insurance coverage and the service is covered by the OHC, that provider should advise the recipient
Page updated: November 2023 - Medi-Cal Medi-Cal Managed Care Plans Beneficiaries enrolled in Medi-Cal Managed Care Plans (MCPs) must receive Medi-Cal medical supply benefit from plan providers After January 1, 2022, these products transitioned to Medi-Cal Rx and are reimbursable through Medi-Cal Rx as a pharmacy-billed item