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GHPP Frequently Asked Questions for Providers

  1. Can I bill GHPP electronically?
  2. How can I appeal the denial of a request for service to be rendered to the client?
  3. How do I submit a claim to GHPP?
  4. How can I apply for a Medi-Cal provider number?
  5. The TAR I submitted to Medi-Cal is denied because the patient is enrolled with GHPP. How do I bill GHPP?
  6. Does GHPP require prior authorization?
  7. How do I verify client’s GHPP program eligibility?
  8. How do I complete the SAR form?
  9. What is a straight GHPP client?
  10. How do I get a CGP number?
  11. How do I get reimbursed for dental services I provided to a GHPP clients?
  12. What is the GHPP rate for dental services?
  13. Can I provide services to GHPP clients if I do not have a Medi-Cal provider number?
  14. Medicare Part D 

 

1. Can I bill GHPP electronically?

At this time, you cannot bill the GHPP electronically. You must submit a paper claim. The instructions on how to bill GHPP are located at the bottom portion of the authorization form.

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2. How can I appeal the denial of a request for service to be rendered to the client?

If the GHPP has denied the service authorization request, you may appeal the denial by writing an appeal letter. Please include any supporting documentation with your appeal. Mail the appeal letter to the following:

  • Attn: Nurse Consultant III
    Genetically Handicapped Persons Program
    MS 8100, P.O. Box 997413
    Sacramento, CA 95899-7413

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3. How do I submit a claim to GHPP?

There are instructions at the bottom portion of the authorization on how to bill GHPP. The authorization is a document that GHPP will send to the provider if the service authorization request has been approved.  

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4. How can I apply for a Medi-Cal provider number?

Call Medi-Cal at 1-800-541-5555 (outside of California, please call 916-636-1980) or visit the Medi-Cal website.

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5. The TAR I submitted to Medi-Cal is denied because the patient is enrolled with GHPP. How do I bill GHPP?

Fax a service authorization request to the GHPP. You may also fax the denial letter from Medi-Cal.

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6. Does GHPP require prior authorization?

GHPP is a prior authorization program. You must submit a service authorization request (SAR) prior to providing services to the GHPP clients. However, there are some exceptions to the prior authorization such as emergency medical services.

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7. How do I verify a client’s GHPP program eligibility?

a. By swiping in the computer the client’s Benefit Identification Card at the point of service. GHPP eligibility is linked to the Medi-Cal database

b. By checking the client’s eligibility in the on-line Medi-Cal database

c. By calling the GHPP at 1-800-639-0597

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8. How do I complete the SAR form?

There is an instruction page when you download the SAR form. The instructions are self explanatory. There are three SAR forms:

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9. What is a straight GHPP client?

A straight GHPP client is a client with current GHPP enrollment who does not have Medi-Cal coverage. Example:

a. Client with Medicare A & B and enrolled with GHPP

b. Client with no other health coverage other than GHPP

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10. How do I get a CGP number?

CGP stands for CCS/GHPP Provider. This is a unique number assigned to the CCS/GHPP providers. At this time, the only providers who need a CGP number are DENTAL providers that are treating straight GHPP clients. All other providers are to use their Medi-cal ID number and National Provider Identification (NPI) number when submitting the claims to the GHPP.

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11. How do I get reimbursed for dental services I provided to a GHPP clients?

a. If you are treating straight GHPP clients, you must submit a completed service authorization request (SAR) to the GHPP for approval. (See question # 8)

b. If you are treating Medi-Cal clients, you must send claims directly to Denti-Cal.

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12. What is the GHPP rate for dental services?

GHPP dental services are paid at the same rate as Medi-Cal and Denti-Cal.

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13. Can I provide services to GHPP clients if I do not have a Medi-Cal provider number?

No. If you are interested in becoming a Medi-Cal provider, call 1-800-541-5555 (outside of California, please call 916-636-1980) or visit the Medi-Cal website.

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Last modified on: 11/5/2015 11:21 AM