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Part 1 – Medi-Cal

107,473 Bytes216,064 Bytes

Medi-Cal Program

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Medi-Cal Provider Manual Contents

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Manual Organization (0Amanorg)

23,528 Bytes117,248 Bytes

How to Use This Manual (0Bhwtouse)

18,979 Bytes98,304 Bytes

Getting Started: Where to Find the Answers D (0Cgetstart)

8,020 Bytes38,912 Bytes

Contents Part 1 – Medi-Cal Program and Eligibility (1toc)

15,389 Bytes77,312 Bytes

AEVS: General Instructions (aev gen)

17,446 Bytes102,912 Bytes

AEVS: Transactions (aev trn)

4,895 Bytes31,232 Bytes

Form: Automated Eligibility Verification System (AEVS) Response Log

17,231 Bytes104,448 Bytes

AEVS: Transactions – SOFP (aev trn sofp)

29,179 Bytes193,536 Bytes

Aid Codes Master Chart (aid codes)

7,510 Bytes48,640 Bytes

Appeal Process Overview (appeal)

8,022 Bytes76,800 Bytes

Checkwrite Schedule (check)

8,050 Bytes49,664 Bytes

CIF Overview (cif)

8,050 Bytes54,272 Bytes

Claim Payment Flowchart (claim pay)

8,377 Bytes51,712 Bytes

Claim Payment Flowchart (claim pay)

34,533 Bytes202,240 Bytes

Claim Submission and Timeliness Overview (claim sub)

8,500 Bytes48,640 Bytes

CMC (cmc)

31,178 Bytes98,816 Bytes

CMC Enrollment Procedures (cmc enroll)

4,629 Bytes27,136 Bytes

CMC Enrollment Checklist (cmc enroll check)

14,259 Bytes67,072 Bytes

Form: Medi-Cal Telecommunications Provider and Biller Application/Agreement

12,629 Bytes69,632 Bytes

Form: CHDP Telecommunications Provider and Biller Application/Agreement

3,722 Bytes27,136 Bytes

Form: Application/Agreement Form Attachment for EMC*Express Users

10,086 Bytes67,584 Bytes

County Medical Services Program (CMSP) (county med)

8,396 Bytes52,736 Bytes

Electronic Fund Transfer (eft)

8,195 Bytes39,424 Bytes

Form: Electronic Fund Transfer Authorization

6,194 Bytes35,328 Bytes

Electronic Methods for Eligibility Transactions and Claim Submissions (elect)

9,166 Bytes44,544 Bytes

Eligibility: Recipient Identification (elig rec)

735,111 Bytes782,848 Bytes

Eligibility: Recipient Identification Cards (elig rec crd)

8,192 Bytes49,664 Bytes

Eligibility: Service Restrictions (elig rstrict)

7,542 Bytes44,544 Bytes

Eligibility: Special Groups (elig special)

40,269 Bytes65,024 Bytes

Health Access Programs (HAP) (health acces)

8,148 Bytes41,984 Bytes

MCP: An Overview of Managed Care Plans (mcp an over)

30,619 Bytes233,472 Bytes

MCP: Code Directory (mcp code dir)

15,785 Bytes85,504 Bytes

MCP: County Organized Health System (COHS) (mcp cohs)

17,399 Bytes94,720 Bytes

MCP: Geographic Managed Care (GMC) (mcp gmc)

15,021 Bytes78,336 Bytes

MCP: Prepaid Health Plan (PHP) (mcp pre)

10,577 Bytes56,320 Bytes

MCP: Primary Care Case Management (PCCM) (mcp prim)

14,902 Bytes77,824 Bytes

MCP: Special Projects (mcp spec)

14,177 Bytes72,704 Bytes

MCP: Two-Plan Model (mcp two plan)

17,581 Bytes95,744 Bytes

Medicare/Medi-Cal Crossover Claims Overview (medicare)

11,085 Bytes67,072 Bytes

OBRA and IRCA (obra)

14,320 Bytes85,504 Bytes

Other Health Coverage (OHC) Codes Chart (other)

9,050 Bytes44,544 Bytes

Other Health Coverage (OHC) Guidelines for Billing (other guide)

13,876 Bytes84,480 Bytes

Percent Programs (percent)

6,371 Bytes30,720 Bytes

Point of Service (POS) (point)

7,363 Bytes36,864 Bytes

Form: Medi-Cal Point of Service (POS) Network/Internet Agreement

4,897 Bytes24,064 Bytes

Form: Point of Service (POS) Device Usage Agreement

4,556 Bytes22,016 Bytes

Form: Medi-Cal Eligibility Verification Enrollment Form

23,931 Bytes111,104 Bytes

Programs Overview (prog)

22,867 Bytes106,496 Bytes

Provider Guidelines (prov guide)

13,472 Bytes63,488 Bytes

Provider Guidelines:Billing Compliance (prov guide bil)

148,799 Bytes189,952 Bytes

Form: “Pay-To” Address Change Notification

3,411 Bytes28,160 Bytes

Form: Provider: Medi-Cal Hardcopy Biller Notification Form

3,541 Bytes27,648 Bytes

Form: Biller: Medi-Cal Hardcopy Biller Application Agreement

88,694 Bytes196,608 Bytes

Provider Regulations (prov reg)

20,361 Bytes109,056 Bytes

Provider Relations Directory (prov rel)

9,394 Bytes59,904 Bytes

Form: Telephone Service Center (TSC) Reference Guide (prov rel frm 1 ref)

9,404 Bytes67,072 Bytes

Form: Medi-Cal Telephone Specialized Operator Reference Guide (prov rel frm 2)

29,787 Bytes160,256 Bytes

Provider Telecommunications Network (PTN) (prov tele)

86,260 Bytes237,568 Bytes

Remittance Advice Details (RAD) and Medi-Cal Financial Summary (remit)

7,418 Bytes45,568 Bytes

Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment (remit and)

23,760 Bytes133,632 Bytes

Remittance Advice Details (RAD) Codes and Messages: 001 – 099 (remit cd001)

16,505 Bytes80,896 Bytes

Remittance Advice Details (RAD) Codes and Messages: 100 – 199 (remit cd100)

13,454 Bytes76,800 Bytes

Remittance Advice Details (RAD) Codes and Messages: 200 – 299 (remit cd200)

14,324 Bytes82,944 Bytes

Remittance Advice Details (RAD) Codes and Messages: 300 – 399 (remit cd300)

12,837 Bytes82,432 Bytes

Remittance Advice Details (RAD) Codes and Messages: 400 – 499 (remit cd400)

9,479 Bytes73,216 Bytes

Remittance Advice Details (RAD) Codes and Messages: 500 – 599 (remit cd500)

15,284 Bytes91,136 Bytes

Remittance Advice Details (RAD) Codes and Messages: 600 – 699 (remit cd600)

9,749 Bytes70,144 Bytes

Remittance Advice Details (RAD) Codes and Messages: 700 – 799 (remit cd700)

4,238 Bytes39,936 Bytes

Remittance Advice Details (RAD) Codes and Messages: 800 – 899 (remit cd800)

3,420 Bytes26,624 Bytes

Remittance Advice Details (RAD) Codes and Messages: 900 – 999 (remit cd900)

46,175 Bytes276,992 Bytes

Remittance Advice Details (RAD) Codes and Messages: 9000 – 9999 (remit cd9000)

11,245 Bytes79,872 Bytes

Remittance Advice Details (RAD): Electronic (remit elect)

32,263 Bytes347,648 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 001 - 099 (remit elect corr001)

28,495 Bytes250,368 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 100 - 199 (remit elect corr100)

29,969 Bytes269,824 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 200 - 299 (remit elect corr200)

33,473 Bytes367,104 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 300 - 399 (remit elect corr300)

26,983 Bytes288,256 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 400 - 499 (remit elect corr400)

26,902 Bytes320,512 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 500 - 599 (remit elect corr500)

31,829 Bytes368,128 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 600 - 699 (remit elect corr600)

17,262 Bytes191,488 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 700 - 799 (remit elect corr700)

7,510 Bytes50,688 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 800 - 899 (remit elect corr800)

40,267 Bytes520,192 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9001 - 9099 (remit elect corr9000)

34,992 Bytes418,304 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9100 - 9199 (remit elect corr9100)

15,736 Bytes131,072 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9200 - 9299 (remit elect corr9200)

26,371 Bytes292,352 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9500 - 9599 (remit elect corr9500)

21,955 Bytes187,904 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9600 - 9699 (remit elect corr9600)

23,301 Bytes238,592 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9700 - 9799 (remit elect corr9700)

24,525 Bytes257,536 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9800 - 9899 (remit elect corr9800)

11,192 Bytes91,136 Bytes

RAD to ARC to HCRC Correlation Table: 9900 - 9999 (remit elect corr9900)

18,732 Bytes143,360 Bytes

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: HCRC to RAD (remit elect corr hcrc)

15,741 Bytes72,192 Bytes

Form: Electronic Health Care Claim Payment/Advice Receiver Agreement (ANSI ASC X12N 835 Transaction)

13,038 Bytes79,360 Bytes

Resubmission Turnaround Document (RTD) Overview (resub)

19,808 Bytes93,696 Bytes

Share of Cost (SOC) (share)

658,422 Bytes779,264 Bytes

TAR Overview (tar)



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