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Provider Manuals
Part 1 - Medi-Cal Program and Eligibility
Medi-Cal Program (00medi-cal)
(Revision Date Apr 16, 2021) |
95KB)
How to Use This Manual (0B hw to use)
(Revision Date Feb 16, 2022) |
392KB)
Getting Started: Where to Find the Answers (0C get start)
(Revision Date Jan 14, 2022) |
269KB)
AEVS: General Instructions (aev gen)
(Revision Date May 14, 2021) |
211KB)
AEVS: Transactions (aev trn)
(Revision Date May 14, 2021) |
201KB)
Form: Automated Eligibility Verification System (AEVS) Response Log (aev trn1 form)
(Revision Date Mar 10, 2023) |
74KB)
Aid Codes Master Chart (aid codes)
(Revision Date Jan 13, 2023) |
381KB)
Appeal Process Overview (appeal)
(Revision Date Mar 16, 2023) |
109KB)
Checkwrite (check)
(Revision Date Jun 16, 2022) |
160KB)
CIF Overview (cif)
(Revision Date Mar 16, 2023) |
120KB)
Claim Payment Flowchart (claim pay)
(Revision Date Dec 31, 2021) |
129KB)
Claim Submission and Timeliness Overview (claim sub)
(Revision Date Mar 16, 2023) |
280KB)
CMC (cmc)
(Revision Date Mar 16, 2023) |
114KB)
CMC Enrollment Procedures (cmc enroll)
(Revision Date Mar 16, 2023) |
127KB)
County Medical Services Program (CMSP) (county med)
(Revision Date Sep 16, 2021) |
71KB)
Electronic Fund Transfer (eft)
(Revision Date Dec 16, 2021) |
113KB)
Form: Electronic Fund Transfer Authorization (eft form)
(Revision Date Mar 7, 2023) |
91KB)
Electronic Methods for Eligibility Transactions and Claim Submissions (elect)
(Revision Date Dec 31, 2021) |
131KB)
Eligibility: Recipient Identification (elig rec)
(Revision Date Dec 31, 2021) |
127KB)
Eligibility: Recipient Identification Cards (elig rec crd)
(Revision Date Aug 16, 2021) |
331KB)
Eligibility: Service Restrictions (elig rstrict)
(Revision Date Aug 14, 2020) |
112KB)
Eligibility: Special Groups (elig special)
(Revision Date Mar 8, 2023) |
106KB)
Health Access Programs (HAP) (health acces)
(Revision Date Jan 15, 2021) |
121KB)
MCP: An Overview of Managed Care Plans (mcp an over)
(Revision Date Jan 14, 2022) |
141KB)
MCP: Code Directory (mcp code dir)
(Revision Date Jan 13, 2023) |
292KB)
MCP: County Organized Health System (COHS) (mcp cohs)
(Revision Date Sep 16, 2022) |
215KB)
MCP: Geographic Managed Care (GMC) (mcp gmc)
(Revision Date Jan 31, 2023) |
224KB)
MCP: Imperial, San Benito and Regional Models (mcp imperial)
(Revision Date Jan 31, 2023) |
149KB)
MCP: Primary Care Case Management (PCCM) (mcp prim)
(Revision Date Jan 14, 2022) |
156KB)
MCP: Special Projects (mcp spec)
(Revision Date Mar 16, 2023) |
173KB)
MCP: Two-Plan Model (mcp two plan)
(Revision Date Jan 31, 2023) |
228KB)
Medicare/Medi-Cal Crossover Claims Overview (medicare)
(Revision Date Feb 16, 2023) |
178KB)
OBRA and IRCA (obra)
(Revision Date Apr 15, 2022) |
153KB)
Other Health Coverage (OHC) Guidelines for Billing (other guide)
(Revision Date Mar 16, 2023) |
205KB)
Percent Programs (percent)
(Revision Date Apr 15, 2022) |
162KB)
Form: Medi-Cal Point of Service (POS) Network/Internet Agreement (point frm1 net)
(Revision Date Mar 8, 2023) |
83KB)
Form: Medi-Cal Eligibility Verification Enrollment Form (point frms)
(Revision Date Mar 7, 2023) |
89KB)
Medi-Cal Procedure/Drug Code Limitation Introduction (proc intro)
(Revision Date Oct 16, 2020) |
102KB)
Medi-Cal Procedure/Drug Code Limitation List (proc list)
(Revision Date Nov 16, 2022) |
66KB)
Programs Overview (prog)
(Revision Date Jun 16, 2022) |
215KB)
Provider Guidelines (prov guide)
(Revision Date Mar 16, 2023) |
196KB)
Provider Guidelines: Billing Compliance (prov guide bil)
(Revision Date Aug 31, 2020) |
136KB)
Form: Provider: Medi-Cal Hardcopy Biller Notification Form (prov guide frm2 prv)
(Revision Date Mar 6, 2023) |
63KB)
Form: Biller: Medi-Cal Hardcopy Biller Application Agreement (prov guide frm3 bil)
(Revision Date Mar 7, 2023) |
72KB)
Provider Regulations (prov reg)
(Revision Date Dec 31, 2021) |
363KB)
Provider Relations Directory (prov rel)
(Revision Date Mar 16, 2023) |
178KB)
Form: TSC Main Menu Prompt Options (prov rel frm1 ref)
(Revision Date Dec 31, 2021) |
105KB)
Form: AEVS Main Menu Prompt Options (prov rel frm2)
(Revision Date Jan 15, 2021) |
98KB)
Form: Main Menu Prompt Options (prov rel frm3)
(Revision Date Aug 31, 2020) |
100KB)
Provider Telecommunications Network (PTN) (prov tele)
(Revision Date Mar 16, 2023) |
252KB)
Remittance Advice Details (RAD) and Medi-Cal Financial Summary (remit)
(Revision Date Mar 16, 2023) |
190KB)
Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment (remit and)
(Revision Date Mar 16, 2023) |
116KB)
Remittance Advice Details (RAD): Electronic (remit elect)
(Revision Date Mar 16, 2023) |
161KB)
Share of Cost (SOC) (share)
(Revision Date Dec 16, 2022) |
563KB)
TAR Overview (tar)
(Revision Date Mar 16, 2023) |
819KB)
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