• MC 1054 (6/07): Carta del proveedor de Medi-Cal sobre el costo compartido
• MC 1982 A (07/12) – SD/MC Quarterly Claim for Reimbursement – Treatment Cost
• MC 1982 B (07/12) – SD/MC Quarterly Claim for Reimbursement – Administrative Cost
  Alt: MC 1982 B (Excel)
• MC 1982 C (07/12) – SD/MC Monthly Claim for Reimbursement – Quality Assurance/Utilization Review (QA/UR) Cost
• MC 1982 D (07/12) – Solicitud trimestral de reembolso SD/MC – Actividades administrativas de Medi-Cal (MAA)
  Alt: MC 1982 D – (Excel)