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Medi-Cal County Inmate Program Effective Date Changed

December 22, 2016

A NewsFlash article published October 11, 2016, informed providers that they may submit claims directly to the Department of Health Care Services (DHCS) Fiscal Intermediary (FI) for Medi-Cal County Inmate Program (MCIP) for dates of service on or after October 24, 2016, once the county responsible for the inmate signed a Medi-Cal County Inmate Program Agreement. However, these agreements will not be effective until April 1, 2017, at the earliest.

Therefore, effective for dates of service on or after April 1, 2017, providers may submit MCIP claims to DHCS consistent with standard fee-for-service Medi-Cal billing for participating counties only. Claims will be denied if the responsible county is not participating in MCIP.

Currently, MCIP claims submitted for dates of service before April 1, 2017, are suspending. These suspended claims will be denied, and providers should submit these claims to the county of incarceration responsible for arranging and paying for medical care of the inmates.

Providers should not submit Treatment Authorization Requests (TARs) for MCIP services in participating counties until April 1, 2017. TARs will be reviewed and adjudicated based solely on medical necessity with the applicable MCIP aid codes. There is no verification of allowable services or county participants for TARs submitted by providers. An approved TAR does not guarantee payment for services to the provider.

To receive updates regarding which counties are participating in MCIP, subscribe to the Medi-Cal County Inmate Program ListServ by emailing a request to DHCSIMCU@dhcs.ca.gov.