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​​​​Doula Services Frequently Asked Questions

​Provider Dispute Resolution Process

​The Department of Health Care Services (DHCS) covers doula services in both managed care and fee-for-service delivery systems for pregnant and postpartum individuals. Services include non-medical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion.

1. When can I expect payment from a MCP after I submit a claim for services provided to a Medi-Cal member?

  • ​Managed Care Plans (MCPs) are required to pay 90 percent of all "clean claims" wsithin 30 calendar days of receipt, unless the provider and MCP have agreed in writing to an alternate payment schedule. A "clean claim" is a claim that does not need to returned to the provider for corrections or additional information in order to be paid.​

2. What is the process for doulas who are dealing with a denied claim or delays in claims reimbursement?

  • As network providers, doulas have a right to address their concerns about timely payemnts by following up through their applicable MCPs provider dispute resolution process (see question #3).
  • MCPs must have a provider dispute resolution mechanism that includes a timely, fair, and cost-effective dispute resolution process where providers can submit disputes.
  • Providers may submit a dispute to MCPs regarding:
    • ​The authorization or denial of a service.
    • The processing of a payment or non-payment of a claim.
    • The timeliness of the reimbursement on an uncontested clean claim and any interest the MCP is required to pay on claims reimbursement.​

​​3. How do I initiate a provider dispute resolution process with a MCP?

4. What should I do it I continue to face challenges after initiating a provider dispute with the MCP?

  • ​If a doula has initiated a provider dispute with their applicable MCP and continues to face challenges, the doula can reach out to DHCS for further assistance via email at DoulaBenefit@dhcs.ca.gov.​
  • Doulas must provide enough detailed information to enable DHCS to effectively follow up with MCPs. Please include information, such as:
    • Doula Name
    • Doula National Provider Identifier number
    • Name of MCP(s) with whom you are having challenges
    • Contracting status (executed contracted or Letter of Agreement/Single Case Agreement)
    • Brief description of the issue. Please include:
      • ​Date(s) of service
      • Confirmation/claim number(s)
      • Outstanding balance(s)
      • Age of claims associated with the issue
    • When did the Doula initiate the MCPs provider dispute process?
    • What specific responses has the doul received from the MCP(s) via the provider dispute process?
    • Name of any MCP representatives that you spoke to regarding the issue, MCPs email or phone number used to make contact.
    • Douls contact information for follow-up (email and/or phone number preferred).
    • DO NOT include protected health information (PHI) unless requested and shared securely.


Last modified date: 9/11/2025 1:49 PM