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Provider Manuals
Part 1 - Medi-Cal Program and Eligibility
Medi-Cal Program (00medi-cal)
(Revision Date Aug 31, 2020) | (95KB)
How to Use This Manual (0B hw to use)
(Revision Date Sep 16, 2020) | (371KB)
Getting Started: Where to Find the Answers (0C get start)
(Revision Date Jan 15, 2021) | (273KB)
AEVS: General Instructions (aev gen)
(Revision Date Jan 15, 2021) | (213KB)
AEVS: Transactions (aev trn)
(Revision Date Jan 15, 2021) | (206KB)
Form: Automated Eligibility Verification System (AEVS) Response Log (aev trn1 form)
(Revision Date Aug 31, 2020) | (74KB)
Aid Codes Master Chart (aid codes)
(Revision Date Nov 16, 2020) | (490KB)
Appeal Process Overview (appeal)
(Revision Date Aug 31, 2020) | (98KB)
Checkwrite (check)
(Revision Date Sep 16, 2020) | (150KB)
CIF Overview (cif)
(Revision Date Sep 16, 2020) | (117KB)
Claim Payment Flowchart (claim pay)
(Revision Date Aug 14, 2020) | (121KB)
Claim Submission and Timeliness Overview (claim sub)
(Revision Date Jan 15, 2021) | (280KB)
CMC (cmc)
(Revision Date Sep 16, 2020) | (115KB)
CMC Enrollment Procedures (cmc enroll)
(Revision Date Sep 16, 2020) | (160KB)
CMC Enrollment Checklist (cmc enroll check)
(Revision Date Sep 16, 2020) | (59KB)
County Medical Services Program (CMSP) (county med)
(Revision Date Aug 14, 2020) | (120KB)
Electronic Fund Transfer (eft)
(Revision Date Aug 14, 2020) | (110KB)
Form: Electronic Fund Transfer Authorization (eft form)
(Revision Date Sep 22, 2020) | (91KB)
Electronic Methods for Eligibility Transactions and Claim Submissions (elect)
(Revision Date Aug 14, 2020) | (107KB)
Eligibility: Recipient Identification (elig rec)
(Revision Date Aug 14, 2020) | (124KB)
Eligibility: Recipient Identification Cards (elig rec crd)
(Revision Date Aug 31, 2020) | (468KB)
Eligibility: Service Restrictions (elig rstrict)
(Revision Date Aug 14, 2020) | (112KB)
Eligibility: Special Groups (elig special)
(Revision Date Aug 14, 2020) | (117KB)
Health Access Programs (HAP) (health acces)
(Revision Date Jan 15, 2021) | (121KB)
MCP: An Overview of Managed Care Plans (mcp an over)
(Revision Date Aug 31, 2020) | (117KB)
MCP: Code Directory (mcp code dir)
(Revision Date Feb 17, 2021) | (302KB)
MCP: County Organized Health System (COHS) (mcp cohs)
(Revision Date Sep 16, 2020) | (221KB)
MCP: Geographic Managed Care (GMC) (mcp gmc)
(Revision Date Sep 16, 2020) | (228KB)
MCP: Imperial, San Benito and Regional Models (mcp imperial)
(Revision Date Sep 16, 2020) | (227KB)
MCP: Primary Care Case Management (PCCM) (mcp prim)
(Revision Date Aug 31, 2020) | (184KB)
MCP: Special Projects (mcp spec)
(Revision Date Feb 17, 2021) | (147KB)
MCP: Two-Plan Model (mcp two plan)
(Revision Date Sep 16, 2020) | (231KB)
Medicare/Medi-Cal Crossover Claims Overview (medicare)
(Revision Date Aug 31, 2020) | (180KB)
OBRA and IRCA (obra)
(Revision Date Aug 14, 2020) | (139KB)
Other Health Coverage (OHC) Guidelines for Billing (other guide)
(Revision Date Sep 16, 2020) | (195KB)
Percent Programs (percent)
(Revision Date Aug 31, 2020) | (141KB)
Form: Medi-Cal Point of Service (POS) Network/Internet Agreement (point frm1 net)
(Revision Date Oct 16, 2020) | (167KB)
Form: Medi-Cal Eligibility Verification Enrollment Form (point frms)
(Revision Date Oct 16, 2020) | (120KB)
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 Sep 1, 2020) | (81KB)
Programs Overview (prog)
(Revision Date Aug 31, 2020) | (203KB)
Provider Guidelines (prov guide)
(Revision Date Dec 16, 2020) | (186KB)
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 Aug 31, 2020) | (56KB)
Form: Biller: Medi-Cal Hardcopy Biller Application Agreement (prov guide frm3 bil)
(Revision Date Aug 31, 2020) | (71KB)
Provider Regulations (prov reg)
(Revision Date Aug 31, 2020) | (300KB)
Provider Relations Directory (prov rel)
(Revision Date Aug 31, 2020) | (193KB)
Form: TSC Main Menu Prompt Options (prov rel frm1 ref)
(Revision Date Aug 31, 2020) | (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 Dec 16, 2020) | (258KB)
Remittance Advice Details (RAD) and Medi-Cal Financial Summary (remit)
(Revision Date Sep 16, 2020) | (209KB)
Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment (remit and)
(Revision Date Aug 31, 2020) | (135KB)
Remittance Advice Details (RAD): Electronic (remit elect)
(Revision Date Nov 30, 2020) | (168KB)
Share of Cost (SOC) (share)
(Revision Date Aug 31, 2020) | (548KB)
TAR Overview (tar)
(Revision Date Jan 15, 2021) | (497KB)
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