Mental Health Forms

Back to Mental Health Licensing and Certification

Medi-Cal Manual Claim Forms

MC 1982 A: SD/MC Quarterly Claim for Reimbursement - Treatment Cost
MC 1982 B: Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement - Administrative Cost:

MC 1982 C: SD/MC Monthly Claim for Reimbursement - Quality Assurance/Utilization Review (QA/UR) Cost
MC 1982 D: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)
MC 1982 G: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)

BHIS Certification Forms

DHCS Application Portal Approval Forms

ITWS Certification Forms

Mental Health Certification Forms

Other Mental Health Forms

Last modified date: 4/26/2022 9:25 AM