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Part 1 - Medi-Cal Program and Eligibility

Medi-Cal Program (00medi-cal) (Revision Date May 29, 2020) | (132KB)

Medi-Cal Provider Manual Contents (Revision Date May 29, 2020) | (81KB)

Manual Organization (0Amanorg) (Revision Date May 29, 2020) | (92KB)

How to Use This Manual (0Bhwtouse) (Revision Date May 29, 2020) | (206KB)

Getting Started: Where to Find the Answers (0C get start) (Revision Date May 29, 2020) | (134KB)

Contents Part 1 – Medi-Cal Program and Eligibility (1toc) (Revision Date May 29, 2020) | (140KB)

AEVS: General Instructions (aev gen) (Revision Date May 29, 2020) | (46KB)

AEVS: Transactions (aev trn) (Revision Date May 29, 2020) | (232KB)

Form: Automated Eligibility Verification System (AEVS) Response Log (aev trn1 form) (Revision Date May 29, 2020) | (69KB)

AEVS: Transactions – SOFP (aev trn sofp) (Revision Date May 29, 2020) | (97KB)

Aid Codes Master Chart (aid codes) (Revision Date Jul 16, 2020) | (450KB)

Appeal Process Overview (appeal) (Revision Date May 29, 2020) | (74KB)

Checkwrite (check) (Revision Date Jun 16, 2020) | (77KB)

CIF Overview (cif) (Revision Date May 29, 2020) | (88KB)

Claim Payment Flowchart (claim pay) (Revision Date May 29, 2020) | (88KB)

Claim Submission and Timeliness Overview (claim sub) (Revision Date May 29, 2020) | (301KB)

CMC (cmc) (Revision Date May 29, 2020) | (81KB)

CMC Enrollment Procedures (cmc enroll) (Revision Date May 29, 2020) | (124KB)

CMC Enrollment Checklist (cmc enroll check) (Revision Date May 29, 2020) | (66KB)

County Medical Services Program (CMSP) (county med) (Revision Date May 29, 2020) | (130KB)

Electronic Fund Transfer (eft) (Revision Date May 29, 2020) | (87KB)

Form: Electronic Fund Transfer Authorization (eftform) (Revision Date May 29, 2020) | (91KB)

Electronic Methods for Eligibility Transactions and Claim Submissions (elect) (Revision Date May 29, 2020) | (69KB)

Eligibility: Recipient Identification (elig rec) (Revision Date May 29, 2020) | (91KB)

Eligibility: Recipient Identification Cards (elig rec crd) (Revision Date May 29, 2020) | (781KB)

Eligibility: Service Restrictions (elig rstrict) (Revision Date May 29, 2020) | (75KB)

Eligibility: Special Groups (elig special) (Revision Date May 29, 2020) | (35KB)

Health Access Programs (HAP) (health acces) (Revision Date May 29, 2020) | (133KB)

MCP: An Overview of Managed Care Plans (mcp an over) (Revision Date May 29, 2020) | (88KB)

MCP: Code Directory (mcp code dir) (Revision Date Jul 16, 2020) | (315KB)

County Organized Health System (COHS) (mcp cohs) (Revision Date Jun 16, 2020) | (171KB)

MCP: Geographic Managed Care (GMC) (mcp gmc) (Revision Date Jun 16, 2020) | (200KB)

MCP: Imperial, San Benito and Regional Models (mcp imperial) (Revision Date Jun 16, 2020) | (190KB)

MCP: Primary Care Case Management (PCCM) (mcp prim) (Revision Date May 29, 2020) | (146KB)

MCP: Special Projects (mcp spec) (Revision Date Jul 16, 2020) | (193KB)

MCP: Two-Plan Model (mcp two plan) (Revision Date Jun 16, 2020) | (178KB)

Medicare/Medi-Cal Crossover Claims Overview (medicare) (Revision Date May 29, 2020) | (149KB)

OBRA and IRCA (obra) (Revision Date May 29, 2020) | (144KB)

Other Health Coverage (OHC) Guidelines for Billing (other guide) (Revision Date Jun 16, 2020) | (208KB)

Percent Programs (percent) (Revision Date May 29, 2020) | (247KB)

Form: Medi-Cal Point of Service (POS) Network/Internet Agreement (point frm 1 net) (Revision Date May 29, 2020) | (160KB)

Form: Medi-Cal Eligibility Verification Enrollment Form (point frms) (Revision Date May 29, 2020) | (74KB)

Medi-Cal Procedure/Drug Code Limitation Introduction (proc intro) (Revision Date Jun 10, 2020) | (73KB)

Medi-Cal Procedure/Drug Code Limitation List (proc list) (Revision Date Jun 16, 2020) | (100KB)

Programs Overview (prog) (Revision Date May 29, 2020) | (208KB)

Provider Guidelines (prov guide) (Revision Date May 29, 2020) | (122KB)

Provider Guidelines:Billing Compliance (prov guide bil) (Revision Date May 29, 2020) | (135KB)

Form: Provider: Medi-Cal Hardcopy Biller Notification Form (prov guide frm2 prv) (Revision Date May 29, 2020) | (9KB)

Form: Biller: Medi-Cal Hardcopy Biller Application Agreement (prov guide frm3 bil) (Revision Date May 29, 2020) | (10KB)

Provider Regulations (prov reg) (Revision Date May 29, 2020) | (311KB)

Provider Relations Directory (prov rel) (Revision Date May 29, 2020) | (170KB)

Form: TSC Main Menu Prompt Options (prov rel frm1 ref) (Revision Date May 29, 2020) | (65KB)

Form: AEVS Main Menu Prompt Options (prov rel frm 2) (Revision Date May 29, 2020) | (13KB)

Form: Main Menu Prompt Options (prov rel frm3) (Revision Date May 29, 2020) | (13KB)

Provider Telecommunications Network (PTN) (prov tele) (Revision Date May 29, 2020) | (299KB)

Remittance Advice Details (RAD) and Medi-Cal Financial Summary (remit) (Revision Date May 29, 2020) | (131KB)

Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment (remit and) (Revision Date May 29, 2020) | (116KB)

Remittance Advice Details (RAD) Codes and Messages: 001 – 099 (remit cd001) (Revision Date Jun 16, 2020) | (240KB)

Remittance Advice Details (RAD) Codes and Messages: 100 – 199 (remit cd100) (Revision Date Jun 16, 2020) | (180KB)

Remittance Advice Details (RAD) Codes and Messages: 200 – 299 (remit cd200) (Revision Date May 29, 2020) | (42KB)

Remittance Advice Details (RAD) Codes and Messages: 300 – 399 (remit cd300) (Revision Date May 29, 2020) | (333KB)

Remittance Advice Details (RAD) Codes and Messages: 400 – 499 (remit cd400) (Revision Date Jun 16, 2020) | (154KB)

Remittance Advice Details (RAD) Codes and Messages: 500 – 599 (remit cd500) (Revision Date May 29, 2020) | (149KB)

Remittance Advice Details (RAD) Codes and Messages: 600 – 699 (remit cd600) (Revision Date May 29, 2020) | (42KB)

Remittance Advice Details (RAD) Codes and Messages: 700 – 799 (remit cd700) (Revision Date May 29, 2020) | (231KB)

Remittance Advice Details (RAD) Codes and Messages: 800 – 899 (remit cd800) (Revision Date May 29, 2020) | (186KB)

Remittance Advice Details (RAD) Codes and Messages: 900 – 999 (remit cd900) (Revision Date May 29, 2020) | (16KB)

Remittance Advice Details (RAD) Codes and Messages: 1800 - 1899 (remit cd1800) (Revision Date May 29, 2020) | (14KB)

Remittance Advice Details (RAD) Codes and Messages: 9000 – 9999 (remit cd9000) (Revision Date Jun 16, 2020) | (385KB)

Remittance Advice Details (RAD): Electronic (remit elect) (Revision Date May 29, 2020) | (112KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 001 - 099 (remit elect corr001) (Revision Date Jun 16, 2020) | (418KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 100 - 199 (remit elect corr100) (Revision Date May 29, 2020) | (631KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 200 - 299 (remit elect corr200) (Revision Date May 29, 2020) | (482KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 300 - 399 (remit elect corr300) (Revision Date May 29, 2020) | (519KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 400 - 499 (remit elect corr400) (Revision Date Jun 16, 2020) | (339KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 500 - 599 (remit elect corr500) (Revision Date May 29, 2020) | (410KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 600 - 699 (remit elect corr600) (Revision Date May 29, 2020) | (225KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 700 - 799 (remit elect corr700) (Revision Date May 29, 2020) | (104KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 800 - 899 (remit elect corr800) (Revision Date May 29, 2020) | (28KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 900 - 999 (remit elect corr900) (Revision Date May 29, 2020) | (14KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 1800 - 1899 (remit elect corr1800) (Revision Date May 29, 2020) | (16KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9001 - 9099 (remit elect corr9000) (Revision Date May 29, 2020) | (490KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9100 - 9199 (remit elect corr9100) (Revision Date Jun 16, 2020) | (404KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9200 - 9299 (remit elect corr9200) (Revision Date May 29, 2020) | (491KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9300 – 9399 (remit elect corr9300) (Revision Date May 29, 2020) | (120KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9500 - 9599 (remit elect corr9500) (Revision Date Jun 16, 2020) | (349KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9600 - 9699 (remit elect corr9600) (Revision Date May 29, 2020) | (203KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9700 - 9799 (remit elect corr9700) (Revision Date May 29, 2020) | (283KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9800 - 9899 (remit elect corr9800) (Revision Date May 29, 2020) | (232KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 9900 – 9999 (remit elect corr9900) (Revision Date May 29, 2020) | (391KB)

Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: RARC to RAD (remit elect corr rarc) (Revision Date May 29, 2020) | (141KB)

Share of Cost (SOC) (share) (Revision Date May 29, 2020) | (394KB)

TAR Overview (tar) (Revision Date May 29, 2020) | (478KB)

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