Reminder: Claim Status and Adjudication Guidance

October 6, 2021
  • Providers wishing to check the status of their claims are encouraged to refer to the “Checking Medi-Cal Claim Status” section of the Medi-Cal Frequently Asked Questions (FAQs) page for step-by-step instructions.

  • The FAQs page also provides answers to common questions regarding Treatment Authorization Requests (TARs), Computer Media Claims (CMC) submission, contacting Medi-Cal, overpayment, recipient eligibility verification, common denials and using the Medi-Cal website.

  • For information regarding claim adjustments, reconsideration of denied claims or adjustments please refer to the CIF Overview section of the Part 1- Medi-Cal Program and Eligibility Provider Manual. Detailed instructions are located in the CIF Completion section in the Part 2 Medi-Cal Provider Manual.

  • For information regarding the appeals process, including acknowledgment of appeals, claim appeal status and appeal response letters, please refer to the Appeal Process Overview section of the Part 1‑ Medi-Cal Program and Eligibility Provider Manual. Detailed instructions are located in the Appeal Form Completion section in the Part 2 Provider Manual.

  • Please note that medical records or other documentation cannot be attached to a previously adjudicated claim; therefore, the methods outlined above should be utilized for claim follow-up. Letters of inquiry related to previously adjudicated claims should not be mailed to addresses designated for claim submissions. Please refer to the Contact Us section of the Medi-Cal website for correspondence addresses.

  • If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.