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

Part 2 – Long Term Care (LTC)

111,557 Bytes206,848 Bytes

Medi-Cal Program (00medi-cal)

3,922 Bytes22,016 Bytes

Medi-Cal Provider Manual Contents

9,015 Bytes30,208 Bytes

Manual Organization (0Amanorg)

23,816 Bytes86,016 Bytes

How to Use This Manual (0Bhwtouse)

22,202 Bytes84,992 Bytes

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

11,909 Bytes43,520 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Long Term Care (LTC) (2toc ltc)

8,121 Bytes28,160 Bytes

Accommodation Codes for Long Term Care (accom cd ltc)

1,431,176 Bytes1,511,936 Bytes

Admissions and Discharges (admis)

112,485 Bytes166,400 Bytes

Appeal Form Completion (appeal form)

126,123 Bytes209,920 Bytes

CIF Completion (cif co)

153,717 Bytes215,040 Bytes

CIF Special Billing Instructions for Long Term Care (cif sp ltc)

64,864 Bytes100,864 Bytes

CIF Submission and Timeliness Instructions (cif sub)

3,727 Bytes27,136 Bytes

Distinct-Part Long Term Care Facilities (distinct)

16,587 Bytes60,416 Bytes

EPSDT (epsdt)

13,843 Bytes43,520 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,676 Bytes32,256 Bytes

Forms Reorder Request: Guidelines (forms reo)

145,813 Bytes269,824 Bytes

Forms Reorder Request: Long Term Care (forms reo ltc)

31,746 Bytes119,296 Bytes

Incontinence Medical Supplies (incont)

78,687 Bytes130,560 Bytes

Leave of Absence, Bed Hold, and Room and Board (leave)

14,320 Bytes53,248 Bytes

Licensing and Certification for Long Term Care (licens ltc)

4,166 Bytes30,208 Bytes

Form: SNF/ICF Physician Recertification For Medi-Cal

18,949 Bytes69,632 Bytes

Medicare/Medi-Cal Crossover Claims: Long Term Care (medi cr ltc)

474,696 Bytes589,824 Bytes

Medicare/Medi-Cal Crossover Claims: Long Term Care Billing Examples (medi cr ltc ex)

7,445 Bytes50,688 Bytes

Mental Disease Institutions Directory (mental)

28,207 Bytes115,200 Bytes

Optional Benefits Exclusion (opt ben exc)

16,821 Bytes59,904 Bytes

Other Health Coverage (OHC) (oth hlth)

10,871 Bytes46,592 Bytes

Patient Plans of Care for Long Term Care (patient ltc)

166,667 Bytes267,264 Bytes

Payment Request for Long Term Care (25-1) Completion (pay ltc comp)

18,968 Bytes78,336 Bytes

Payment Request for Long Term Care (25-1): Submission and Timeliness Instructions (pay ltc sub)

12,918 Bytes48,128 Bytes

Payment Request for Long Term Care (25-1): Tips for Billing (pay ltc tips)

448,316 Bytes614,400 Bytes

Preadmission Screening Resident Review (PASRR) (preadmis)

12,367 Bytes44,032 Bytes

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

14,710 Bytes50,176 Bytes

Rates: Facilities (rate facil)

30,945 Bytes162,304 Bytes

Rates: Facility Per Diem (rate facil diem)

13,776 Bytes48,128 Bytes

Rates: Facility Reimbursement - Miscellaneous Inclusive and Exclusive Items (rate facil misc)

12,139 Bytes40,448 Bytes

Remittance Advice Details (RAD) (remit adv)

28,725 Bytes181,248 Bytes

Remittance Advice Details (RAD) Examples: Long Term Care (remit ex ltc)

10,686 Bytes35,328 Bytes

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

5,662 Bytes34,816 Bytes

Rural Hospital Swing Bed Program (rural hosp)

87,013 Bytes147,968 Bytes

Share of Cost (SOC): 25-1 for Long Term Care (share ltc)

12,148 Bytes44,544 Bytes

Sign Language Interpretation (sign)

12,551 Bytes46,592 Bytes

Subacute Care Programs: Adult (subacut adu)

12,807 Bytes56,832 Bytes

Subacute Care Programs: Billing Codes (subacut code)

13,657 Bytes51,200 Bytes

Subacute Care Programs: Level of Care for Adults and Children (subacut lev)

14,250 Bytes59,392 Bytes

Form: Information for Authorization/Reauthorization of Subacute Care Services – Adult Subacute Program (DHS 6200 A)

17,691 Bytes70,144 Bytes

Subacute Care Programs: Pediatric (subacut ped)

388,029 Bytes469,504 Bytes

TAR Completion for Long Term Care (tar comp ltc)

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)

29,312 Bytes121,856 Bytes

TAR Field Office Addresses (tar field)

19,120 Bytes75,776 Bytes

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

1,707,779 Bytes1,774,592 Bytes

TAR for Long Term Care: MDS Form (tar ltc mds)

104,194 Bytes151,552 Bytes

TAR Submission: Transmittal Form (tar submis)

10,532 Bytes33,792 Bytes

TAR: Submitting Appeals (tar submit)

6,860 Bytes49,152 Bytes

Utilization Review: ICF/DD, ICF/DD-H and ICF/DD-N Facilities (util review)



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