این صفحه اطلاعات و منابعی در مورد نحوه ثبت نام برای تبدیل شدن به یک ارائه دهنده Medi-Cal، کمک هزینه صدور صورت حساب و ادعای ارائه دهنده، و مزایای تحت پوشش Medi-Cal، از جمله سیاست های پوشش، ارائه می دهد.​​ 

ثبت نام ارائه دهنده 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 همچنین مسئول توسعه خط مشی ثبت نام، و به روز رسانی و نگهداری اطلاعات ارائه دهنده در پایگاه داده Master Provider File است که در فرآیند پرداخت مطالبات استفاده می شود.​​  

Medi-Cal providers can learn more about DHCS/PED, or contact them directly.​​ 

راهنمای ارائه دهنده Medi-Cal و بولتن های ارائه دهنده​​ 

ارائه دهندگان Medi-Cal به کتابچه راهنمای ارائه دهنده Medi-Cal و بولتن های ارائه دهنده دسترسی دارند که خط مشی پوشش و بازپرداخت Medi-Cal را تشریح می کند.​​ 

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.​​ 

کمک هزینه صدور صورت حساب و ادعای ارائه دهنده 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).​​ 

ارائه دهندگان Medi-Cal می توانند از طریق تلفن (800) 541-5555 (خارج از کالیفرنیا، (916) 636-1980)، دوشنبه تا جمعه، به جز روزهای تعطیل، از 8:00 صبح تا 5:00 بعد از ظهر با مرکز خدمات تلفنی (TSC) تماس بگیرند. برای دسترسی سریعتر به منابع TSC، ارائه دهندگان Medi-Cal می توانند به راهنمای گزینه های منوی اصلی TSC مراجعه کنند.​​ 

از طریق واحد صورت‌حساب ارائه‌دهنده کوچک، DHCS همچنین برای ارائه‌دهندگان Medi-Cal که حداکثر 100 ادعای Medi-Cal را در ماه ارسال می‌کنند و از خدمات صورت‌حساب یا آژانس استفاده نمی‌کنند، ارائه می‌کند. ارائه دهندگان Medi-Cal می توانند با واحد صورتحساب ارائه دهنده کوچک با شماره تلفن 916) 636-1275، از دوشنبه تا جمعه، به جز روزهای تعطیل، از ساعت 8 صبح تا 12 بعد از ظهر و از ساعت 13:00 تا 5:00 بعدازظهر تماس بگیرند.​​ 

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.​​ 

آموزش ارائه دهنده 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.​​ 

علاوه بر این، پرتال آموزشی Medi-Cal به ارائه دهندگان و صورتحساب های Medi-Cal آموزش آنلاین خودسرانه درباره مبانی صورتحساب، خط مشی ها، رویه ها، ابتکارات جدید و تغییرات آتی در برنامه Medi-Cal ارائه می دهد.​​ 

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.​​ 

خط تلفن سلامت باروری (نه 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.​​ 

مزایای 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]​​