Para proveedores de Medi-Cal
Esta página proporciona información y recursos sobre cómo inscribirse para convertirse en proveedor de Medi-Cal, asistencia para la facturación y reclamaciones del proveedor, y los beneficios cubiertos por Medi-Cal, incluidas las pólizas de cobertura.
Inscripción de proveedores de Medi-Cal
To serve Medi-Cal members, providers must first submit a provider enrollment application with the Department of Health Care Services’ (DHCS’) Provider Enrollment Division (PED).
DHCS/PED is responsible for the enrollment and re‑enrollment of Medi-Cal fee-for-service (FFS) providers who can then directly serve Medi-Cal FFS members and bill DHCS as well as subsequently contract with individual Medi-Cal managed care plans (MCPs) to become network providers to serve Medi-Cal managed care members. For more information about Medi-Cal managed care and contracting with Medi-Cal MCPs to become network providers, please see DHCS’ website.
DHCS/PED también es responsable de desarrollar la política de inscripción y de actualizar y mantener la información del proveedor en la base de datos del Archivo Maestro del Proveedor que se utiliza en el proceso de pago de reclamaciones.
Medi-Cal providers can learn more about DHCS/PED, or contact them directly.
Manual para proveedores de Medi-Cal y boletines para proveedores
Los proveedores de Medi-Cal tienen acceso al Manual del Proveedor de Medi-Cal y a los Boletines para Proveedores, que describen la cobertura y la política de reembolso de Medi-Cal.
Medi-Cal providers are also strongly encouraged to sign up for DHCS’ Medi-Cal Subscription Service (MCSS), which is a free service that keeps Medi-Cal providers up-to-date on the latest Medi-Cal news. Medi-Cal providers who subscribe will receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website.
Asistencia para la facturación y reclamaciones de proveedores de Medi-Cal
Medi-Cal providers have access to billing and claims assistance through DHCS’ California Medicaid Management Information System (CA-MMIS) and its contracted Fiscal Intermediary (FI). CA-MMIS and FI staff can assist providers with questions about paper claim submissions, electronic claim submission, and Treatment Authorization Requests (TARs and electronic-TARs, or eTARs).
Los proveedores de Medi-Cal pueden comunicarse con el Centro de Servicios Telefónicos (TSC, por sus siglas en inglés) por teléfono al (800) 541-5555 (fuera de California, (916) 636-1980), de lunes a viernes, excepto días festivos, de 8:00 a.m. a 5:00 p.m. Para un acceso más rápido a los recursos de TSC, los proveedores de Medi-Cal pueden consultar la Guía de opciones de aviso del menú principal de TSC.
A través de la Unidad de Facturación para Pequeños Proveedores, el DHCS también ofrece un programa completo de asistencia y capacitación para la facturación de proveedores de Medi-Cal que presentan hasta 100 reclamaciones de Medi-Cal por mes y no utilizan un servicio o agencia de facturación. Los proveedores de Medi-Cal pueden comunicarse con la Unidad de Facturación para Pequeños Proveedores por teléfono al 916) 636-1275, de lunes a viernes, excepto días festivos, de 8:00 a.m. a 12:00 p.m. y de 1:00 p.m. a 5:00 p.m.
Medi-Cal providers can also refer to DHCS’ billing Frequently Asked Questions document for more information and refer to applicable sections of the Medi-Cal Provider Manual.
Capacitación para proveedores de Medi-Cal
DHCS’ Outreach and Education (O&E) team offers billing-specific education and support services to Medi-Cal providers and billers, to help providers navigate Medi-Cal and receive timely reimbursement for services.
Además, el Portal de Aprendizaje de Medi-Cal ofrece a los proveedores y facturadores de Medi-Cal capacitación en línea a su propio ritmo sobre los conceptos básicos de facturación, las políticas, los procedimientos, las nuevas iniciativas y los próximos cambios en el programa de Medi-Cal.
In addition to trainings offered through the Medi-Cal Learning Portal, the DHCS/O&E team also facilitates live, virtual and in-person trainings throughout each year. Information on these trainings can be found on DHCS’ website and Medi-Cal providers interested in attending these trainings must register through the Medi Cal Provider Learning Portal Event Calendar.
Medi-Cal providers can also review the information in the Medi-Cal Provider Training workbooks and PowerPoint presentations, which are available for download and can be used at the Medi-Cal provider seminars and other training events.
Línea directa de salud reproductiva (no DHCS)
The Reproductive Health Hotline (ReproHH) is a free, confidential, on-demand phone service staffed by University of California San Francisco’s (UCSF) clinicians who specialize in sexual and reproductive health. It will provide evidence-based clinical information for health care providers with questions about sexual and reproductive health. Funded by the State of California and operated by UCSF’s Department of Family and Community Medicine.
Prestaciones de Medi-Cal
Medi-Cal providers help ensure that Medi-Cal members have access to a core set of health benefits (known as Essential Health Benefits (EHBs)), including doctor visits, hospital care, immunization, pregnancy-related services, prescription drugs, mental health and substance use disorder services, dental, laboratory services, nursing home care, and more. Medi-Cal providers can learn more about specific EHB categories and the services that fall within each on the Department’s website.[HE1]