このページでは、Medi-Calプロバイダーになるための登録方法、プロバイダーの請求と請求支援、および補償ポリシーを含むMedi-Calの補償対象特典に関する情報とリソースを提供します。​​ 

Medi-Calプロバイダーの登録​​ 

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は、登録ポリシーの策定、および請求支払いプロセスで使用されるプロバイダーマスターファイルデータベース内のプロバイダー情報の更新と保守も担当します。​​  

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

Medi-Calプロバイダーマニュアルとプロバイダー速報​​ 

Medi-Calプロバイダーは、Medi-Calのカバレッジと償還ポリシーを概説する Medi-Calプロバイダーマニュアルとプロバイダー速報にアクセスできます。​​ 

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.​​ 

Medi-Calプロバイダーの請求と請求の支援​​ 

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).​​ 

Medi-Calプロバイダーは、(800)541-5555(カリフォルニア州外、(916)636-1980)月曜日から金曜日の午前8時から午後5時まで、電話で電話サービスセンター(TSC)に連絡できます。 TSCリソースにすばやくアクセスするために、Medi-CalプロバイダーはTSCメインメニュープロンプトオプションガイドを参照できます。​​ 

DHCSは、Small Provider Billing Unitを通じて、月に最大100件のMedi-Cal請求を提出し、請求サービスや代理店を使用しないMedi-Calプロバイダー向けに、フルサービスの請求支援とトレーニングプログラムも提供しています。 Medi-Calプロバイダーは、休日を除く月曜日から金曜日の午前8時から午後12時まで、および午後1時から午後5時まで、電話916)636-1275でSmall Provider Billing Unitに連絡できます。​​ 

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.​​ 

Medi-Calプロバイダートレーニング​​ 

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.​​ 

さらに、 Medi-Calラーニングポータル は、Medi-Calプロバイダーと請求者に、請求の基本、ポリシー、手順、新しいイニシアチブ、およびMedi-Calプログラムの今後の変更に関する自分のペースで進められるオンライントレーニングを提供します。​​ 

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.​​ 

リプロダクティブ・ヘルス・ホットライン(DHCSではない)​​ 

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.​​ 

Medi-Calの利点​​ 

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]​​