Welcome New Medi-Cal Providers!

New Provider Checklist

The Department of Health Care Services (DHCS) thanks you for becoming a Medi-Cal provider and joining California’s network of comprehensive health care programs, which serves about 13 million Californians — forming the backbone of California’s health care safety net.

DHCS recommends all newly enrolled Medi-Cal fee-for-service providers use this step-by-step New Provider Checklist to help ensure success prior to submitting a claim for the first time. This checklist will highlight the critical areas and related services available to Medi-Cal providers.

Step 1 – Eligibility

1. Read through the Electronic Methods for Eligibility Transactions and Claim Submissions (elect) manual section in the Part 1 provider manual.


2. Read through the Share of Cost (share) manual section in the Part 1 provider manual.


3. Review the TAR Authorization flyer which highlights services that require authorization.
   

Step 2 – Claim Forms and Claim Submission

1. Utilize the Navigating Medi-Cal and Specialty Health Programs to determine which claim form(s) align to the benefits and services you will render and bill for monthly.


2. Locate and become familiar with the specific Claim Form(s) you will utilize to bill Medi-Cal services each month.


3. Review the Claim Submission and Follow-up Overview flyer for claim timelines and additional submission resources.


4. Review Billing Tips for important and initial Medi-Cal billing information.

Step 3 – Electronic Billing

1. Read through the Electronic Billing flyer.


2. Access the Computer Media Claims (CMC) Submission Instructions for online billing instructions.

Step 4 – Timeliness and Checkwrite Schedule

1. Refer to the Medi-Cal Claims Timeliness Chart for claims submission timelines.


2. Refer to the Checkwrite Schedule located within the Checkwrite section (check) of the Part 1 provider manual for the current year’s schedule.

Step 5 – Transaction Services

1. Review the specific Transaction Enrollment Requirements for Medi-Cal Internet Transactions.


2. Review the list of Transaction Services Available within Medi-Cal Internet Transactions.


3. Access Medi-Cal Transactions via the tile located on the Medi-Cal Provider home page OR by navigating to: Providers Tab > Transactions

Step 6 – General Resources

1. View the Navigating Medi-Cal and Specialty Health Programs and identify the provider communities that you will render benefits and services to.


2. Take the Medi-Cal Website Tour.


3. Visit the Medi-Cal Provider Publications page. Then proceed to your specific provider community page(s). It is recommended that you bookmark these pages for quick and easy access.

Note: Within these provider community pages, you will find Medi-Cal News, monthly Medi-Cal Update Bulletins, Provider Manuals and Featured Links to additional key areas such as Billing Tips, Medi-Cal Rates and References.


4. Sign up for the free and easy Medi-Cal Subscription Service (MCSS) to receive tailored Medi-Cal news, bulletins and more based on your specific provider communities.
   

Step 7 – Outreach, Education and Provider Training

1. Visit the Medi-Cal Learning Portal (MLP) which can be accessed on the MLP tile located at the bottom of the Medi-Cal Provider home page OR by navigating to:
   
   Providers Tab > Outreach & Education > Launch the Medi-Cal Learning Portal (MLP)


2. Create and register for an MLP account.
   
   
3. Take the Medi-Cal Resources 101 training.


4. View the Provider Training Webinars and Seminars Calendar. Note when a Medi-Cal Provider seminar is coming to a city near you and register online to attend.
   
   Note: Seminars are offered 10 times each year across the State of California.


5. Contact Medi-Cal via the Telephone Service Center (TSC) at 1-800-541-5555 and schedule your first on-site visit with your specific area’s Regional Representative. TSC is also available to assist providers with general inquiries.
   
   Note: If you are a provider billing “fewer than 100 claim lines per month,” consider enrolling in the Small Provider Billing Assistance and Training Program offered by the Small Provider Billing Unit.

Step 8 – Frequently Asked Questions (FAQs)

1. Visit the FAQs web page for helpful answers to questions on a wide variety of topics.


2. Read through each of the materials linked below.
   
   

REFERENCES

• Claim Submission Overview
• Claim Timeliness
• Electronic Billing
• Medi-Cal Subscription Service (MCSS) Flyer
• Online PDF Remittance Advice Details (RADs)
• TAR Authorization