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Medi-Cal Provider Enrollment FAQs

INTRODUCTORY INFORMATION

The enrollment of fee-for-service providers into the Medi-Cal program is the function of the California State Department of Health Care Services’ (DHCS) Provider Enrollment Division (PED).  DHCS contracts with a separate, private company, Xerox State Healthcare, LLC (Xerox), to perform all of the fiscal intermediary functions of the Medi-Cal program. As a rule, all inquiries about billing, claims, POS devices and AEVS number issues should be directed to the Medi-Cal Provider Service Center at (800) 541-5555 or the POS Help Desk at (800) 427-1295. The Provider Service Center is available 8 a.m. to 5 p.m., PST, Monday through Friday, except holidays (border providers and out-of-state billers billing for in-state providers, call [916] 636-1200). For faster access to Service Center resources, refer to the TSC Main Menu Prompt Options Guide and the TSC Specialized Operator Reference Guide. You are encouraged to print these guides and keep them next to your phone for easy reference.

Once PED approves the enrollment application of a provider, PED staff members build the provider file and transmit the information to Xerox. Xerox then sends a Welcome Letter to all billing providers with billing and claims information.  A Provider Identification Number (PIN) is sent by Xerox to billing providers shortly after the Welcome Letter package.

You may scroll down through the entire list of FAQs on this page or, if you prefer, you may search the FAQs according to the topic links which follow:

Enrollment Requirements

Application Processing Questions

 

 

Provider Number/ National Provider Identifier (NPI)

Purchase/Sale of a Medi-Cal Enrolled Business 

Deactivation of a Provider 

Billing for Services 

Provider Identification Number (PIN) (not NPI)

Emergency Room Services

Provider Termination 

Miscellaneous

Crossover Only Enrollment

 

1. Where do applicants find information regarding enrollment requirementsFor information regarding provider enrollment, please refer to the Statutes, Regulations, and Provider Bulletins section and the Application Packages Alphabetical by Provider Type section of the Provider Enrollment page. Applicants and providers are encouraged to review the forms and enrollment regulations available on the Medi-Cal Web site. The regulations contain application criteria and terminology, processing timelines, and the requirements for participation in the Medi-Cal program.

 

2. How do applicants and providers report a change in their enrollment information? Enrolled providers are responsible for notifying DHCS within 35 days of any change to their previously submitted information. Please refer to the items listed on the Medi-Cal Supplemental Changes (DHCS 6209) form. If the change in information you need to report does not appear on this form, then you are required to submit a new complete application package, according to your provider type. ONE EXCEPTION to this is that a currently enrolled individual physician or osteopath who is changing their business location within the same county may submit the Medi-Cal Change of Location Form For Individual Physician Practices Relocating Within the Same County (DHCS 9096). You may contact the PED message center at (916) 323-1945 or by email at PEDCorr@dhcs.ca.gov if you have questions about which forms are required to report your specific change.

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3. What are the enrollment requirements when a Successor Liability with Joint and Several Liability Agreement (DHCS 6217) has been completed? Upon the sale or transfer of a Medi-Cal enrolled business, and when the parties elect to complete a Successor Liability with Joint and Several Liability Agreement, by letter postmarked no later than five days after the occurrence of any the five events listed below, the provider transferor (seller) and the transferee applicant (buyer) shall submit to DHCS the completed Successor Liability with Joint and Several Liability Agreement (DHCS 6217), signed and dated by both parties.

(1) A sale or transfer of 50 percent or more of the assets owned by the corporation at the location for which a provider number was issued;

(2) A cumulative change in the person(s) with an ownership or control interest of 50 percent or more that has occurred since the information provided in the last complete application package approved for enrollment;

(3) When a new Taxpayer Identification Number is issued by the Internal Revenue Service (IRS);

(4) When the Board of Pharmacy requires a new site permit, pursuant to Chapter 9 (commencing with Section 4000) Division 2 of the Business and Professions Code;

(5) A change of ownership as defined in California Code of Regulations (CCR), Title 22, Section 51000.6.

Secondly, the transferee applicant (buyer) must submit a complete application package, appropriate to their provider type, to DHCS, within 35 days of the occurrence of any of the events listed above.

N.B. A provider number is not transferable pursuant to CCR, Title 22, Section 51000.52 (b), except when a transferee applicant meets the successor liability with joint and several liability requirements set forth in CCR, Title 22, Section 51000.32. Therefore, without completion of the agreement, the transferor (seller) remains solely liable after the close of the sale, until such time that the transferee (buyer) becomes an enrolled provider. Should the buyer subsequently fail to become enrolled as a Medi-Cal provider, the seller continues to solely carry all liability to DHCS for all amounts paid for services, goods, supplies, or merchandise, provided directly or indirectly, to Medi-Cal beneficiaries.                                    Back to Top

4. What has changed regarding enrollment application requirements as a result of National Provider Identifier (NPI) implementation?  Effective May 23, 2007, applicants/providers were required to submit their NPI with each Medi-Cal application package. Applicants must submit verification of each NPI submitted to DHCS in an application package, including the Medi-Cal Supplemental Changes form, if appropriate. This verification is required each time an applicant or provider submits an application or a Medi-Cal Supplemental Changes form for each NPI application.

Acceptable confirmation includes:

(1) NPI notification letter from the National Plan and Provider Enumerator System (NPPES);

(2) NPI notification e-mail from NPPES, or;

(3) NPI notification from the Electronic File Interchange Organization via letter or e-mail.

If providers are not eligible to receive an NPI, they are not required to submit an NPI and should instead enter the word "atypical" in the NPI field. For more information on the NPI, please refer to NPI: FAQs.

 

5. If we are an enrolled Medi-Cal Group Provider and we want to add a rendering provider to our group, what is the process?

If the rendering provider you wish to add to your group is already actively-enrolled in the Medi-Cal program, no application is needed and the group can begin billing for the rendering provider immediately. If the rendering provider you wish to add to your group is not already actively-enrolled in Medi-Cal, you need to submit a rendering provider application package, using the DHCS 6216 application form.

If you are unsure of the current Medi-Cal status of a rendering provider who you want to add to your group, please send an email to PED to inquire about the status of the new rendering provider. Submit your status inquiry with the provider’s full legal name and NPI number to PEDcorr@dhcs.ca.gov . Or, if you prefer, you can print and complete the Provider Number Verification Form from the Medi-Cal website and mail it to PED.                                                                                                                                                                                Back to Top

6. How do applicants enroll to be Medi-Cal providers? To enroll as a Medi-Cal provider, the appropriate application package must be submitted for the appropriate provider type. For a listing of the required forms by provider type, please refer to the feature on the Provider Enrollment webpage "Application Packages Alphabetical by Provider Type".

• To request an application form, please contact the fiscal intermediary, Xerox, at their Telephone Service Center at (800) 541-5555.

OR

• Download application forms from the Application Forms section of the Provider Enrollment page on the Medi-Cal Web site.

 

7. How do physicians who are new to Medi-Cal request to join an enrolled group? What forms are required?Physicians who are new to Medi-Cal and are joining a Medi-Cal enrolled group must submit the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216).  Providers who are enrolled in Medi-Cal with a current, active provider number (NPI) are not required to submit an application when joining Medi-Cal enrolled groups.

 

8. Who should an applicant contact to answer questions about completing the application? An applicant may contact the Telephone Service Center at (800) 541-5555, the Provider Enrollment Message Center at (916) 323-1945 or submit written question(s) to the Department of Health Care Services, Provider Enrollment Division, MS 4704, P.O. Box 997412, Sacramento, CA 95899-7412 or via email at PEDcorr@dhcs.ca.gov.  DHCS can assist applicants by providing guidance on what forms to complete but DHCS staff may not provide advisory opinions regarding completion of applications. DHCS is specifically prohibited by law from answering questions about interpreting the statutes or regulations and can only cite the statutes and regulations themselves.

To obtain information on the statutory and regulatory requirements for participation in the Medi-Cal program, please refer to the Statutes, Regulations, and Provider Bulletins section or the Application Packages Alphabetical by Provider Type section of the Provider Enrollment page. If unclear about how to interpret Medi-Cal instructions or regulations, please contact your legal counsel for assistance.            Back to Top

9. What are the different address types, how are they used and how can they be changed? The application requests a business, a pay-to, and a mailing address. This information is used as follows:

• The business address is the physical location where services are being rendered. General correspondence will be mailed to this address. Post office or commercial boxes are not acceptable. A change in business address requires submission of a full application package, unless the provider is an individual physician and meets the criteria to use the shorter DHCS 9096 Application Form.

• The pay-to address is the address at which the provider wishes to receive payment for services. Post office or commercial boxes are acceptable. A change in the pay-to address can be made on a provider’s file by submitting all relevant information to Provider Enrollment Division on a Supplemental Changes Form, DHCS 6209.

• The mailing address is the address at which the provider wishes to receive the "Welcome To Medi-Cal" package, the assigned Provider Identification Number notification and any additional informational bulletins. Post office or commercial boxes are acceptable. A change in mailing address can be made on a provider’s file by submitting all relevant information to Provider Enrollment Division on a Supplemental Changes Form, DHCS 6209.

 

10. How does a non-profit entity complete the Medi-Cal Disclosure Statement (DHCS 6207)? Most non-profit organizations are run by a governing board (e.g., Board of Directors). As such, each member of the applicable governing board must be reported. Additionally, although the vast majority of non-profit organizations do not have owners, any individual who owns at least five percent of the non-profit organization must be reported.

 

11. Who can sign the application? The application must be signed under penalty of perjury by an individual who is the sole proprietor, partner, corporate officer or an official representative of a governmental entity or non-profit organization, and who has the authority to legally bind the applicant seeking enrollment as a Medi-Cal provider. Applications must have original signatures.

• Stamped, faxed or copied signatures are not acceptable.

• A photocopy of the application may be submitted, but it must have an original signature.

• It is unlawful to alter a photocopied application form in any manner.

• A biller or office manager is not a valid signatory.                                                                                                           Back to Top

 

12. Where do applicants mail the application?  Completed forms should be mailed to:

Department of Health Care Services

Provider Enrollment Division

MS 4704

P. O. Box 997412

Sacramento, CA 95899-7412

Please note that some of the applications and forms may show this address with a P.O. Box and Zip Code ending with the number three instead of two. Both addresses are current and valid addresses for submission of applications, forms and correspondence, but the address shown above will eventually be published on all documents for submission to the Provider Enrollment Division.  NOTE: Provider Enrollment staff cannot meet with individual applicants. An application cannot be delivered in person to the DHCS.

 

13. How long does it take to process the application? Applications are reviewed and processed in accordance with Medi-Cal provider enrollment statutes and regulations. The review of an applicant’s or provider’s application package is a complex process that requires assessment of many elements of the application, including a review of the required supporting documentation, to determine eligibility for enrollment into the Medi-Cal program. DHCS may conduct a background check of an applicant or provider for the purpose of verifying information. This background check may include an unannounced onsite inspection, a review of business records and data searches to ensure that the applicant or provider meets enrollment criteria.

Effective July 1, 2008, DHCS provides an "acknowledgment of receipt letter" for an application package from a physician or a physician group within 15 days. For applications from provider types other than physicians or physician groups, a written notice confirming receipt is mailed within 30 days. This letter also may notify applicants whether a moratorium exists on their provider type.

Effective July 1, 2008, physician and physician group applicants are notified in writing of one of the four actions listed below, within 90 days of receipt of an application. Notification of DHCS action to applicants other than a physician or physician group remains at 180 days.

• The application is approved for enrollment as a provisional provider;

• The application is incomplete and additional information is required;

• The application is referred for a comprehensive review and background check; or

• The application is denied with the reason(s) for denial.

Effective July 1, 2008, "Preferred" provider applications are statutorily required to be processed in 60 days if all the required documentation is submitted. If all appropriate documentation is not submitted, the application may take up to 90 days to process. For information regarding the criteria for "preferred provider status" on our Web site, refer to the Medi-Cal Provider Enrollment Preferred Provider Status article, available on the Provider Enrollment page.

Effective July 1, 2008, DHCS notifies a physician applicant within 15 days of receipt of a Medi-Cal Hospital-Based Physician Application/Disclosure Statement/Agreement (DHCS 9095). Within 90 days, DHCS notifies the applicant of approval or notifies the applicant that the applicant does not meet the required criteria. For more information on the criteria, refer to the AB 1226 – Provider Enrollment Forms & Provisions Effective July 1, 2008 bulletin on the Medi-Cal Web site.                                                                                                                

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14. What happens if applicants submit an incomplete application? Incomplete applications will be returned to the applicant with an explanation of what information is missing, and a request that these items be submitted within the 60-day statutory requirement.

• If a corrected application is returned to DHCS within 60 days of the notice, processing continues.

• If an application is not returned within the 60-day timeframe, then the late resubmitted application is treated as a new application and the application processing timeframe starts over again.

• Within 60 days after receipt of a timely resubmitted application, DHCS notifies applicants/providers of either approved enrollment, referral for a more comprehensive review or denial of enrollment.

 

15. Can applicants check the status of their application? If applicants do not receive an "acknowledgement of receipt letter" from DHCS within the timeframe specified in FAQ #13 above, they may contact the Provider Enrollment Message Center, (916) 323-1945, or submit their inquiry, in writing, via e-mail to PEDCorr@dhcs.ca.gov or to the address listed below:

Department of Health Care Services

Provider Enrollment Division

MS 4704

P. O. Box 997412

Sacramento, CA 95899-7412

In order to conduct research efficiently, please include the provider’s name and professional license number, social security number and/or tax identification number. If checking on the status of an application and you have received an acknowledgment of receipt letter, please also include in your written request a copy of the acknowledgement of receipt letter from the Provider Enrollment Division showing the six-digit document number assigned to the application. Also include this six-digit document number in any email status check requests.

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16. How are applicants notified of their application approval or disapproval?  When an application package is approved, providers receive a "Welcome To Medi-Cal" letter and packet, which includes the effective date of enrollment for the approved service location. This approval letter and welcome package is sent to the provider’s mailing address from Xerox, the Medi-Cal fiscal intermediary.

When an application package is denied, applicants/providers are notified by letter from the Provider Enrollment Division, that the application package is denied. The specific reasons for the denial are listed in the notification letter.

 

17. What determines the effective date of a provider’s enrollment? The effective date of enrollment is the date a complete application is received by the Provider Enrollment Division, which is identified on a notice issued to the provider to acknowledge the application was received. For additional information on the specifics of effective date determination, please read the Medi-Cal Provider Enrollment Effective Date Determination provider bulletin, published in June 2004 .

 

18. Can an applicant or provider submit a photocopy or a faxed copy of the application package? A photocopy of the application package is acceptable; however, the signature on it must be an original. Stamped, faxed or copied signatures are not acceptable. Although the form may be photocopied, it is unlawful to alter it in any manner. If a mistake is made entering information on a form, line through the mistake and initial it. Do not use correction tape, white out, etc., to make corrections.

 

19. What are the rules for using the provider number? Each approved provider has agreed to abide by all program requirements published in the Medi-Cal provider manual. No provider shall submit claims to the Medi-Cal program using any provider number other than that issued to the provider by DHCS, or their assigned NPI number.

Providers agree that they have no property right in or to their status as a provider in the Medi-Cal program or in or to their provider number(s), and that a provider may not assign their provider number or any rights and obligations it has under a Medi-Cal Provider Agreement, unless allowed as described in the Requirements and Procedures for Successor Liability article.

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20. Who do providers contact regarding a lost provider number? If a provider number is lost, the provider must submit a Medi-Cal Provider Number Verification Form to PED. The request must be signed by the provider and include a photocopy of his or her medical license, and driver’s license, or state-issued identification card. This form can be found online on the Provider Enrollment page, under "Application Forms by Form Name and Number".

 

21. What is the process for buying a Medi-Cal enrolled business? If you purchase a Medi-Cal enrolled business and you have entered into and submitted to PED (within 5 days of the purchase transaction completion) a valid Successor Liability with Joint and Several Liability Agreement, you are considered to be a transferee applicant. "Transferee Applicant" means an individual or entity that joins a provider transferor’s Medi-Cal provider agreement including the use of the provider number issued for that location when any of the following occur:

(1) A sale or transfer of 50 percent or more of the assets owned by the corporation at the location for which a provider number was issued;

(2) A cumulative change in the person(s) with an ownership or control interest of 50 percent or more that has occurred since the information provided in the last complete application package approved for enrollment;

(3) When a new Taxpayer Identification Number is issued by the IRS;

(4) When the Board of Pharmacy requires a new site permit, pursuant to chapter 9 (commencing with Section 4000) Division 2 of the Business and Professions Code;

(5) A change of ownership as defined in CCR, Title 22, Section 51000.6.

If you have any of the above circumstances and the transferor (seller) elects to complete a Successor Liability with Joint and Several Liability Agreement, you, the transferee (buyer), must also submit to DHCS, within 35 days of the occurrence of any event listed above, a complete application package pursuant to CCR, Title 22, Section 51000.30.

N.B. A provider number is not transferable pursuant to CCR, Title 22, Section 51000.52(b), except when a transferee applicant meets the successor liability with joint and several liability requirements set forth in CCR, Title 22, Section 51000.32. Therefore, without completion of the agreement, the transferor (seller) remains solely liable after the close of the sale, until such time that the transferee (buyer) becomes an enrolled provider. Should the buyer subsequently fail to become enrolled as a Medi-Cal provider, the seller continues solely to carry all liability to DHCS for all amounts paid for services, goods, supplies, or merchandise, provided directly or indirectly, to Medi-Cal beneficiaries.

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22. What is the process for selling a Medi-Cal enrolled business? If you sell a Medi-Cal enrolled business and you have entered into and submitted to PED (within 5 days of sales transaction completion) a valid Successor Liability with Joint and Several Liability Agreement you would be considered to be a transferor. As the transferor, upon the sale of the business, you may elect successor liability with joint and several liability by meeting both of the following conditions:

(1) By letter postmarked no later than five days after the occurrence of any event listed in CCR, Title 22, Section 51000.30(b), the provider transferor and the transferee applicant shall submit to DHCS the Successor Liability with Joint and Several Liability Agreement (DHCS 6217), signed and dated by both, which includes the following information:

• The legal name of the provider transferor which shall be the name currently on file with the IRS;

• Current provider number for the location affected;

• Fictitious business name of the provider transferor, if applicable;

• The legal name of transferee applicant, which shall be the name currently on file with the IRS;

• Current provider number(s) of transferee applicant, if applicable;

• Fictitious business name of the transferee applicant, if applicable;

A statement signed and dated by both the provider transferor and the transferee applicant wherein they accept joint and several liability for all debt arising from the Medi-Cal provider agreement applicable to the location for which a provider number was issued by DHCS.

(2) The transferee applicant (buyer) shall submit to DHCS within 35 days of the occurrence of any event listed in CCR, Title 22, Section 51000.30(b), a complete application package pursuant to Title 22, Section 51000.30.

N.B. A provider number is not transferable pursuant to CCR, Title 22, Section 51000.52(b), except when a transferee applicant meets the successor liability with joint and several liability requirements set forth in CCRm Title 22, Section 51000.32. Therefore, without completion of the agreement, the transferor (seller) remains solely liable after the close of the sale, until such time that the transferee (buyer) becomes an enrolled provider. Should the buyer subsequently fail to become enrolled as a Medi-Cal provider, the seller continues to solely carry all liability to DHCS for all amounts paid for services, goods, supplies, or merchandise, provided directly or indirectly, to Medi-Cal beneficiaries.

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23. Why should providers consider completing a Successor Liability with Joint and Several Liability Agreement (DHCS 6217)? A provider number is not transferable (CCR, Title 22, Section 51000.52[b]), except when a transferee applicant meets the successor liability with joint and several liability requirements set forth in CCR, Title 22, Section 51000.32. Therefore, without completion of the agreement, the transferor (seller) remains solely liable after the close of the sale, until such time that the transferee (buyer) becomes an enrolled provider. Should the buyer subsequently fail to become enrolled as a Medi-Cal provider, the seller continues to solely carry all liability to DHCS for all amounts paid for services, goods, supplies, or merchandise, provided directly or indirectly, to Medi-Cal beneficiaries.

"Successor Liability with Joint and Several Liability" means a provider transferor (seller) joins a transferee applicant (buyer) to its Medi-Cal agreement, including its rights to use the provider number issued for that location. Through this process, the transferor (seller) and the transferee (buyer) become jointly liable for all debts that are incurred for the period of time that it takes to determine if the transferee (buyer) will be enrolled with his/her own new provider number and/or until the new number is active. Completion of the form is elective on the part of the provider. However, if he/she elects to utilize this provision, he/she must strictly comply with its provisions.

 

24. When can a provider number be deactivated without notification? A provider number is deactivated when:

• Warrants or documents mailed to the service or business address or the pay-to address were returned by the United States Postal Service as not deliverable. 

• A claim has not been submitted for reimbursement from the provider for one year.

• A Medi-Cal enrolled business is sold and the new owner (transferee) has been subsequently approved for enrollment.

Prior to deactivating a provider number for either of the first two reasons above, DHCS makes an attempt to contact the provider by telephone or mail. If unable to make contact, DHCS is required to deactivate the provider number immediately without prior notice. For additional information about deactivation for returned mail or for non-participation, please refer to Welfare and Institutions (W&I) Code, Section 14043.62(a) for the full text of the statute and the Provider Guidelines section of the Part 1 manual.  

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25. Can provider numbers be reactivated? Submission of a complete application package specific to the provider type is required for provider number reactivation.

In cases where a deactivation was due to DHCS sanctions, re-application may be subject to specific restrictions. Detailed information is included with the written notification to a sanctioned provider.

 

26. When can providers start billing for services? After an application has been approved, Medi-Cal providers receive a Welcome Letter and package from Xerox, which contains billing information. Usually within 2-3 weeks after receiving the Welcome Letter and package, the provider receives a separate notification from Xerox with their Provider Identification Number (PIN). Once the provider has received their PIN, they can begin verifying eligibility of their Medi-Cal patients and begin their billing process.

NOTE: Prospective Medi-Cal providers must apply for and be enrolled in the Medi-Cal program and agree to conditions of participation before claim submission or payment can be made for services furnished to Medi-Cal recipients. Prior to approval of the application, an applicant’s decision to see Medi-Cal patients is at their own personal risk for payment.

 

27. Who bills Medi-Cal for the services of rendering providers and locum tenens physicians? Rendering providers cannot bill directly; it is the group entity that bills Medi-Cal for the services rendered by the providers enrolled in their group.

In reimbursement for locum tenens/reciprocal billing, the recipient’s regular physician may submit the claim and receive payment for covered Medicaid services (including emergency visits and related services) provided by a locum tenens physician who is not an employee of the regular physician.

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28. Where can providers find answers to other billing questions? For assistance with billing and claims, please contact the Telephone Service Center at (800) 541-5555 or online at "Contact Medi-Cal".  For the most current information about billing and claims submission, refer to the "Medi-Cal Newsroom" area on the Medi-Cal home page and also the Medi-Cal Quick Start Guide

                                                                                                                                                                                                                                                                                                                                                                             

29. Who do providers contact when payments (warrants) for billed services are not received?  If a provider is not receiving payment (warrants) for services that have been billed to the Medi-Cal program, a provider may need to request a change of pay-to address on file with DHCS. Providers are required to notify DHCS within 35 days of the date of a change to the business, and/or pay-to address. For additional information on reporting a change, please return to Question 9, above, or to access the correct form, go to the Provider Enrollment page on the Medi-Cal Web site at www.medi-cal.ca.gov and click on "Application Forms by Form Name and Number." When the address change has been made, providers will be instructed by Provider Enrollment Division about how to request payments be re-issued. Providers also may contact Provider Enrollment Division, Returned Warrant Unit, at (916) 319-8413, or via email at pedretwarr@dhcs.ca.gov.

If interested in applying for Electronic Funds Transfer (EFT), review the EFT Enrollment Authorization form. Complete and send a notarized EFT Enrollment Authorization form and a voided check to:

Attn: EFT Unit

Xerox State Healthcare, LLC 

P.O. Box 13029

Sacramento, CA 95813-4029

 

30: What is the PIN used for? The Provider Identification Number (PIN) is the additional validation of an enrolled provider’s identity that is used when a provider conducts business transactions with the Medi-Cal program and the fiscal intermediary, Xerox. Some examples of transactions requiring use of the PIN would include recipient eligibility verification and submission of a Computer Media Claims (CMC) Agreement to get a submitter ID for electronic billing.

 

31: What is the difference between a PIN and a Submitter ID?  The PIN is the secret code that is used as validation of an enrolled provider’s identity whenever the provider needs to access and transmit information to and from the Medi-Cal program. A Submitter ID is an additional identifier number used specifically for the electronic claims submission process.

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32: I did not receive a PIN, who do I contact?  All inquiries about PIN, billing, claims, POS devices and AEVS number issues should be directed to the Telephone Service Center (TSC) at (800) 541-5555 or the POS Help Desk at (800) 427-1295. The TSC is available 8 a.m. to 5 p.m., Monday through Friday, except holidays (border providers and out-of-state billers billing for in-state providers, call [916] 636-1200). For faster access to TSC resources, refer to the TSC Main Menu Prompt Options Guide and the TSC Specialized Operator Reference Guide. You are encouraged to print these guides and keep them next to your phone for easy reference.

 

33. What determines the effective date of enrollment for provision of Emergency Room Services? DHCS has created an exception for applicants who provide emergency room services or other services to Medi-Cal recipients who come to a hospital emergency room and are treated by practitioners who are required by contract with the acute care hospital or acute psychiatric hospital to treat those patients.

For information on determining the effective date for emergency room services, please review the Medi-Cal Provider Enrollment Effective Date Determination bulletin.

 

34. How do providers terminate their Medi-Cal enrollment?  A Medi-Cal provider may request to be deactivated by submitting a Medi-Cal Supplemental Changes (DHCS 6209) form, along with a cover letter explaining the action requested.

 

35. Where do Medi-Cal recipients acquire a list of Medi-Cal providers? Medi-Cal recipients need to contact their local county office of Health and Human Services for a list of Medi-Cal providers in their county.  A listing of the local county offices can be found on the DHCS Web site.

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36. Are substituting physicians required to apply as a Medi-Cal provider? Locum tenens physicians substituting for actively-enrolled Medi-Cal physicians are not required to be enrolled as Medi-Cal providers when providing locum tenens services to Medi-Cal beneficiaries.

Medicaid Information Release MA01-19, Procedure for Locum Tenens and Reciprocal Billing, effective August 1, 2001, allows for physicians to bill for locum tenens using the following guidelines:

• Locum tenens is the practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for the substitute physician’s services as though he/she performed them. These substitute physicians are generally called "locum tenens" physicians. Services for recipients are not restricted to the regular physician’s office.

• Locum tenens occurs when the substitute physician covers for the regular physician during absences not to exceed a period of 90 continuous days.

• Reciprocal billing occurs when substitute physicians cover the regular physicians during absences and/or on an on-call basis not to exceed a period of 14 continuous days.

 

37. How do I add or remove the CHDP number on my provider file? You need to contact CHDP at (650) 573-2877.

38. Who are Crossover-Only Providers?

Crossover providers meet two conditions.  The first condition is that they are enrolled in Medicare and are not enrolled in Medi-Cal.  The second condition is that they have provided a service to a dual-eligible beneficiary and are seeking approval for reimbursement of that service from Medi-Cal. 

39. Who is a dual-eligible beneficiary?

A dual-eligible beneficiary is a beneficiary that is eligible for both Medicare and Medi-Cal.

40. How does a Crossover Only provider receive approval for reimbursement for a service provided to a dual-eligible beneficiary by Medi-Cal?

If a provider is Medicare enrolled and not Medi-Cal enrolled and provides services to a beneficiary who is eligible for both Medicare and Medi-Cal, the provider may receive approval for reimbursement for services rendered to the beneficiary by completing and submitting form MC 0804 to the Provider Enrollment Division.  The mailing address is listed on the form. 

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41. Is approval for reimbursement from Medi-Cal automatic for a service provided to a dual-eligible beneficiary?

No.  Form MC 0804 is subject to Departmental approval.  Please read the Crossover Only Provider Bulletin for more information.  Please read MC 0804 form instructions carefully and thoroughly before completing.

42. If I am a provider who is both Medicare and Medi-Cal enrolled, do I need to submit a Crossover Only Provider Form MC 0804 if I provide services to a beneficiary that is both Medicare and Medi-Cal eligible?

No.  If you are a provider who is already enrolled in Medi-Cal, you do not need to fill out MC 0804.  MC 0804 is only applicable to those providers who are not enrolled in Medi-Cal and who do not wish to be enrolled in Medi-Cal.

43. If a provider wishes to enroll in Medi-Cal do they fill out MC 0804?

No.  If a provider wishes to enroll in Medi-Cal, they must submit a complete application package pursuant to CCR, Title 22, Section 51000.30.