Enrollment Requirements for Medi-Cal Internet Transactions
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Automated Provider Services,
Batch Eligibility,
Eligibility,
Medi-Services,
Medicare Drug Pricing,
PDF RAD/Medi-Cal Financial Summary,
Share of Cost
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Must have a Medi-Cal provider number and PIN, and have either an electronic or paper Medi-Cal Point of Service (POS) Network/Internet Agreement form on file:
Electronic POS/Internet form
Paper POS/Internet form
For information about Provider Enrollment, visit the Provider Enrollment page.
Please call the Telephone Service Center (TSC) at 1-800-541-5555 for more information.
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Hospital Presumptive Eligibility (HPE) Program
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Must have a Medi-Cal provider number and PIN, and have either an electronic or paper Medi-Cal Point of Service (POS) Network/Internet Agreement form on file:
Electronic POS/Internet form
Paper POS/Internet form
The provider must be enrolled in the HPE Program.
The provider must have a Hospital Presumptive Eligibility (HPE) Program Provider Election Form and Agreement on file. For questions regarding the form and enrollment, please see the Hospital Presumptive Eligibility (HPE): Provider Enrollment Instructions and the Presumptive Eligibility (HPE) Provider Enrollment Checklist.
Please call the TSC at 1-800-541-5555 for enrollment forms.
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Family PACT
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Must have a Medi-Cal provider number and PIN, and have either an electronic or paper Medi-Cal Point of Service (POS) Network/Internet Agreement form on file:
Electronic POS/Internet form
Paper POS/Internet form
The provider must be enrolled in the Family PACT program.
Please call the TSC at 1-800-541-5555 for enrollment forms.
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BCCTP Enrollment
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Must have a Medi-Cal provider number and PIN, and have either an electronic or paper Medi-Cal Point of Service (POS) Network/Internet Agreement form on file:
Electronic POS/Internet form
Paper POS/Internet form
The provider must be enrolled in the BCCTP program. |
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Pharmacy (RTIP)
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Must have either an electronic or paper Medi-Cal Point of Service (POS) Network/Internet Agreement form on file for each pharmacy provider:
Electronic POS/Internet form
Paper POS/Internet form
Must have Medi-Cal Telecommunications Provider and Biller Application/Agreement on file with a check mark in the “Internet” box under “Real Time Submission Type” and a check mark in the “Pharmacy” box under “NCPDP Version” with a version of “D.0”.
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CMC Upload & Inquiry
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Must have Medi-Cal Telecommunications Provider and Biller Application/Agreement on file with a check mark in the “Internet” box under “CMC Batch Submission Type” and a check mark in the appropriate box(es) in the “Claim Type” area.
Call the TSC at 1-800-541-5555 for information about enrollment.
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Drug Rebate
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To access Labeler Information (i.e. for Drug Rebate), you must download
this
Subscription Form and send it to the address listed on the form.
Please call the Drug Rebate group at 916-636-1217 for any additional
information.
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SCPI/ARDS Downloads
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Must have either a Medi-Cal Electronic Remittance Advice Detail (RAD)
Enrollment form or a Medi-Cal Electronic Remittance Advice Detail (RAD)
Service Agreement form on file.
For information and to enroll in SCPI, contact the California MMIS Fiscal Intermediary by either calling
916-612-5378 or 916-601-7402, or by emailing SCPI@us.ibm.com.
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Managed Care/Insurance Carrier Uploads & Downloads
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Must complete the Medi-Cal website Managed Care Plan/Insurance Carrier
Agreement Form
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Disproportionate Share Hospital (DSH) Eligibility Re-Verification
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Must have a Medi-Cal website Agreement Form for Disproportionate Share
Hospital Eligibility Re-Verification on file.
Call the Medi-Cal Eligibility Division (MCED) at 916-552-9200
for
information.
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