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

Part 1 – Medi-Cal Program and Eligibility

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Medi-Cal Program (00medi-cal)

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Medi-Cal Provider Manual Contents

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Manual Organization (0Amanorg)

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How to Use This Manual (0Bhwtouse)

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

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

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AEVS: General Instructions (aev gen)

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AEVS: Transactions (aev trn)

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Form: Automated Eligibility Verification System (AEVS) Response Log (aev trn1 form)

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AEVS: Transactions – SOFP (aev trn sofp)

56,092 Bytes401,408 Bytes

Aid Codes Master Chart (aid codes)

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Appeal Process Overview (appeal)

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Checkwrite (check)

10,224 Bytes35,840 Bytes

CIF Overview (cif)

9,705 Bytes75,264 Bytes

Claim Payment Flowchart (claim pay)

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Claim Submission and Timeliness Overview (claim sub)

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CMC (cmc)

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CMC Enrollment Procedures (cmc enroll)

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CMC Enrollment Checklist (cmc enroll check)

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Form: Medi-Cal Telecommunications Provider and Biller Application/Agreement (cmc enroll form6153)

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Form: CHDP Telecommunications Provider and Biller Application/Agreement (cmc enroll frm4431)

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County Medical Services Program (CMSP) (county med)

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Electronic Fund Transfer (eft)

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Form: Electronic Fund Transfer Authorization (eftform)

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Electronic Methods for Eligibility Transactions and Claim Submissions (elect)

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Eligibility: Recipient Identification (elig rec)

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Eligibility: Recipient Identification Cards (elig rec crd)

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Eligibility: Service Restrictions (elig rstrict)

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Eligibility: Special Groups (elig special)

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Health Access Programs (HAP) (health acces)

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

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MCP: Code Directory (mcp code dir)

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

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

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MCP: Imperial, San Benito and Regional Models (mcp imperial)

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

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MCP: Special Projects (mcp spec)

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MCP: Two-Plan Model (mcp two plan)

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Medicare/Medi-Cal Crossover Claims Overview (medicare)

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OBRA and IRCA (obra)

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

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Percent Programs (percent)

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Point of Service (POS) (point)

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Form: Medi-Cal Point of Service (POS) Network/Internet Agreement (point frm 1 net)

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Form: Point of Service (POS) Device Usage Agreement (point frm 2 dev)

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Form: Medi-Cal Eligibility Verification Enrollment Form (point frms)

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Medi-Cal Procedure/Drug Code Limitation Introduction (proc intro)

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Medi-Cal Procedure/Drug Code Limitation List (proc list)

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Programs Overview (prog)

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Provider Guidelines (prov guide)

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Provider Guidelines:Billing Compliance (prov guide bil)

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Form: “Pay-To” Address Change Notification (prov guide frm 1 pay)

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Form: Provider: Medi-Cal Hardcopy Biller Notification Form

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Form: Biller: Medi-Cal Hardcopy Biller Application Agreement

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Provider Regulations (prov reg)

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Provider Relations Directory (prov rel)

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Form: TSC Main Menu Prompt Options (prov rel frm1 ref)

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Form: AEVS Main Menu Prompt Options (prov rel frm 2)

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Form: Main Menu Prompt Options (prov rel frm3)

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Provider Telecommunications Network (PTN) (prov tele)

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

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

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

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

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Remittance Advice Details (RAD) Codes and Messages: 1800 - 1899 (remit cd1800)

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

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

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

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

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

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

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

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

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

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

35,528 Bytes324,096 Bytes

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

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

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Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 1800 - 1899 (remit elect corr1800)

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

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

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

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

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

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

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

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Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 900 - 999 (remit elect corr900)

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

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

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

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

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

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

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

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

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

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

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Resubmission Turnaround Document (RTD) Overview (resub)

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Share of Cost (SOC) (share)

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TAR Overview (tar)



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