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Transaction Enrollment Requirements

Enrollment Requirements for Medi-Cal Internet Transactions
Automated Provider Services, Batch Eligibility, Eligibility, Medi-Services, Medicare Drug Pricing, PDF RAD/Medi-Cal Financial Summary, Share of Cost	Must have a Medi-Cal provider number and PIN and have a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file. For information on Provider Enrollment, visit the Provider Enrollment page. Please call the Telephone Service Center (TSC) at 1-800-541-5555 for more information.
Hospital Presumptive Eligibility (HPE) Program	Must have a Medi-Cal provider number and PIN and have a Medi-Cal POS Network/Internet Agreement form on file. 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.
Family PACT	Must have a Medi-Cal provider number and PIN and have a a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file. The provider must be enrolled in the Family PACT program. Please call the TSC at 1-800-541-5555 for enrollment forms.
BCCTP Enrollment	Must have a Medi-Cal provider number and PIN and have a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file. The provider must be enrolled in the BCCTP program.
Pharmacy (RTIP)	Must have a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file for each pharmacy provider. 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”.
CMC Upload & Inquiry	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.
Drug Rebate	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.
SCPI/ARDS Downloads	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. Call (916) 373-7705 for information about enrollment.
Managed Care/Insurance Carrier Uploads & Downloads	Must complete the Medi-Cal website Managed Care Plan/Insurance Carrier Agreement Form
Disproportionate Share Hospital (DSH) Eligibility Re-Verification	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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