Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Part 2 – Inpatient Services (IPS)

106,894 Bytes206,336 Bytes

Medi-Cal Program (00medi-cal)

3,922 Bytes22,016 Bytes

Medi-Cal Provider Manual Contents

7,265 Bytes49,152 Bytes

Manual Organization (0Amanorg)

22,227 Bytes84,992 Bytes

How to Use This Manual (0Bhwtouse)

19,786 Bytes80,384 Bytes

Getting Started: Where to Find the Answers D (0C get start)

12,352 Bytes46,080 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Inpatient Services (2toc ip)

19,700 Bytes103,424 Bytes

Administrative Days (admin)

15,959 Bytes128,512 Bytes

Ancillary Codes (ancil cod)

110,276 Bytes161,792 Bytes

Appeal Form Completion (appeal form)

15,469 Bytes51,712 Bytes

California Children's Services (CCS) Program (cal child)

5,600 Bytes32,768 Bytes

California Children’s Services (CCS) Program Approved Hospitals (cal child appr)

6,830 Bytes35,328 Bytes

California Children's Services (CCS) Program Billing (cal child bil)

6,747 Bytes38,912 Bytes

CCS Program Billing Guidelines (cal child bil guide)

48,780 Bytes77,824 Bytes

California Children's Services (CCS) Program Billing Example: UB-04 Claim Form (cal child bil ub)

20,850 Bytes112,128 Bytes

California Children’s Services (CCS) Program County Office Directory (cal child county)

10,560 Bytes49,664 Bytes

California Children's Services (CCS) Program Eligibility (cal child elig)

9,495 Bytes34,304 Bytes

California Children's Services (CCS) Program Medical Therapy Program (cal child med)

36,132 Bytes67,072 Bytes

California Children's Services (CCS) Program Provider Paneling (cal child panel)

16,759 Bytes90,624 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Physicians and Podiatrists (DHS 4514)

20,274 Bytes102,912 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Allied Health Care Professionals (DHS 4515 )

12,914 Bytes72,704 Bytes

California Children's Services (CCS) Program Referrals (cal child ref)

23,167 Bytes90,624 Bytes

California Children's Services (CCS) Program Service Authorization Request (SAR) (cal child sar)

58,727 Bytes290,816 Bytes

California Children’s Services (CCS) Program Service Code Groupings (cal child ser)

4,199 Bytes26,624 Bytes

California Children’s Services (CCS) Program Special Care Centers (cal child spec)

125,697 Bytes212,992 Bytes

CIF Completion (cif co)

146,931 Bytes213,504 Bytes

CIF Special Billing Instructions for Inpatient Services (cif sp ip)

63,483 Bytes100,352 Bytes

CIF Submission and Timeliness Instructions (cif sub)

89,339 Bytes174,080 Bytes

Contracted and Non-Contracted Inpatient Services (cont ip)

7,590 Bytes26,112 Bytes

Denti-Cal Program (denti)

10,073 Bytes36,864 Bytes

Denti-Cal Program for Inpatient and Outpatient Services (denti io)

26,133 Bytes102,912 Bytes

Diagnosis-Related Groups (DRG): Inpatient Services (diagnosis ip)

13,404 Bytes43,520 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,276 Bytes31,744 Bytes

Forms Reorder Request: Guidelines (forms reo)

35,141 Bytes72,704 Bytes

Forms Reorder Request: Inpatient and Outpatient Services (forms reo io)

29,589 Bytes114,176 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

9,899 Bytes32,768 Bytes

HCPCS Introduction (hcpcs)

11,603 Bytes59,904 Bytes

HCPCS Level III Interim Code List: Reimbursable Medi-Cal-Only Codes (hcpcs iii)

4,378 Bytes30,720 Bytes

Hoptel Services (hoptel)

18,271 Bytes61,440 Bytes

Hospice Care (hospic)

10,456 Bytes48,128 Bytes

Hospital Directory (hospital dir)

20,434 Bytes80,896 Bytes

Hospital Presumptive Eligibility Program Process (hospital presum)

16,532 Bytes62,464 Bytes

Hospital Presumptive Eligibility (PE): Provider Enrollment Instructions (hospital presum prov)

8,905 Bytes32,256 Bytes

Hospital Presumptive Eligibility (PE) Provider Enrollment Checklist (hospital presum prov enroll)

9,756 Bytes34,816 Bytes

Hospital Recoupment: Administrative Adjustment Requests (hosp recoup)

18,712 Bytes90,112 Bytes

Hysterectomy (hyst)

74,484 Bytes135,168 Bytes

Inpatient Mental Health Services Program (inp ment)

25,901 Bytes161,792 Bytes

Inpatient Mental Health Services Program: Plan-Authorization Directory (inp ment pln)

10,085 Bytes34,816 Bytes

Inpatient Rehabilitation Services (inp rehab)

6,729 Bytes34,304 Bytes

Licensing and Certification for Inpatient Services (licens ip)

25,573 Bytes93,184 Bytes

Medicare/Medi-Cal Crossover Claims: Inpatient Services (medi cr ip)

325,036 Bytes467,456 Bytes

Medicare/Medi-Cal Crossover Claims: Inpatient Services Billing Examples (medi cr ip ex)

29,823 Bytes116,224 Bytes

Medicine (medne)

7,445 Bytes50,688 Bytes

Mental Disease Institutions Directory (mental)

12,560 Bytes56,832 Bytes

Minor Consent Program (minor)

13,700 Bytes47,104 Bytes

Newborn Hearing Screening Program (newborn)

19,803 Bytes85,504 Bytes

Obstetrics: Revenue Codes and Billing Policy (ob rev)

23,775 Bytes115,712 Bytes

Obstetrics: Revenue Codes and Billing Policy for DRG-Reimbursed Hospitals (ob rev drg)

33,886 Bytes193,024 Bytes

Obstetrics: Revenue Codes Billing Instructions (ob rev instr)

458,373 Bytes644,608 Bytes

Obstetrics: UB-04 Billing Examples for Inpatient Services (ob ub ex)

415,659 Bytes594,944 Bytes

Obstetrics: UB-04 Billing Examples for Inpatient Services – DRG Payment Method (ob ub ex drg)

31,148 Bytes132,608 Bytes

Optional Benefits Exclusion (opt ben exc)

14,889 Bytes52,736 Bytes

Other Health Coverage (OHC) (oth hlth)

6,665 Bytes46,592 Bytes

Patient Plans of Care for Inpatient Facilities (patient ip)

448,316 Bytes614,400 Bytes

Preadmission Screening Resident Review (PASRR) (preadmis)

13,212 Bytes46,592 Bytes

Pregnancy: Postpartum and Newborn Referral Services (preg post)

11,854 Bytes43,520 Bytes

Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry) (prov bil)

10,070 Bytes52,224 Bytes

Remittance Advice Details (RAD) (remit adv)

25,583 Bytes160,768 Bytes

Remittance Advice Details (RAD) Examples: Inpatient Services (remit ex ip)

10,322 Bytes35,328 Bytes

Remittance Advice Details (RAD): Payments and Claim Status (remit pay)

690,784 Bytes803,328 Bytes

Resubmission Turnaround Document (RTD) Completion (resub comp)

13,911 Bytes76,800 Bytes

Revenue Codes for Inpatient Services (rev cd ip)

13,235 Bytes88,576 Bytes

Form: Revenue Rate Change Request (DHCS 6004)

76,608 Bytes120,832 Bytes

Share of Cost (SOC): UB-04 for Inpatient Services (share ip)

11,715 Bytes45,056 Bytes

Sign Language Interpretation (sign)

1,259,745 Bytes1,418,752 Bytes

Sterilization (ster)

8,056 Bytes27,648 Bytes

TAR and Non-Benefit: Introduction to List (tar and non)

15,908 Bytes66,048 Bytes

TAR and Non-Benefit List: Codes 10000 – 19999 (tar and non cd1)

20,046 Bytes85,504 Bytes

TAR and Non-Benefit List: Codes 20000 – 29999 (tar and non cd2)

24,211 Bytes101,888 Bytes

TAR and Non-Benefit List: Codes 30000 – 39999 (tar and non cd3)

24,315 Bytes108,032 Bytes

TAR and Non-Benefit List: Codes 40000 – 49999 (tar and non cd4)

23,043 Bytes98,304 Bytes

TAR and Non-Benefit List: Codes 50000 – 59999 (tar and non cd5)

20,991 Bytes86,528 Bytes

TAR and Non-Benefit List: Codes 60000 – 69999 (tar and non cd6)

12,449 Bytes46,080 Bytes

TAR and Non-Benefit List: Codes 70000 – 79999 (tar and non cd7)

16,087 Bytes56,320 Bytes

TAR and Non-Benefit List: Codes 80000 – 89999 (tar and non cd8)

26,434 Bytes104,448 Bytes

TAR and Non-Benefit List: Codes 90000 – 99999 (tar and non cd9)

122,667 Bytes191,488 Bytes

TAR Completion (tar comp)

207,574 Bytes258,560 Bytes

TAR Criteria for DP/NF Authorization (Hudman v. Kizer) (tar crit dp)

17,869 Bytes85,504 Bytes

Form: Family Certification

17,330 Bytes84,480 Bytes

Form: Medical Certification

15,949 Bytes102,400 Bytes

Form: Call List for NF Placement

19,946 Bytes89,600 Bytes

TAR Criteria for NF Authorization (Valdivia v. Coye) (tar crit nf)

294,934 Bytes543,232 Bytes

TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer)

27,549 Bytes122,368 Bytes

TAR Field Office Addresses (tar field)

30,664 Bytes135,168 Bytes

TAR for Long Term Care (Form 20-1): Inpatient Services (tar ltc ip)

72,834 Bytes117,760 Bytes

TAR Request for Extension of Stay (Form 18-1) (tar req ext)

104,194 Bytes151,552 Bytes

TAR Submission: Transmittal Form (tar submis)

10,532 Bytes33,792 Bytes

TAR: Submitting Appeals (tar submit)

22,815 Bytes96,768 Bytes

Transplants (transplant)

254,325 Bytes346,112 Bytes

Transplants: Billing Examples for Inpatient Services (transplant ex ip)

6,004 Bytes39,424 Bytes

Transplants: Donor Protocol (transplant proto)

339,044 Bytes536,576 Bytes

UB-04 Completion: Inpatient Services (ub comp ip)

76,436 Bytes114,176 Bytes

UB-04 Completion: Inpatient Services Billing Example (ub comp ip ex)

16,099 Bytes57,856 Bytes

UB-04 Special Billing Instructions for Inpatient Services (ub spec ip)

20,137 Bytes83,456 Bytes

UB-04 Submission and Timeliness Instructions (ub sub)

13,165 Bytes52,736 Bytes

UB-04 Tips for Billing: Inpatient Services (ub tips ip)



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