​​​​County Customer Services Section  Library 

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Aid Code Master Chart (SDMC)

The Aid Code Master Chart (SDMC) is a PDF that is regularly updated. 

​Certification Forms

• MC 1982 A: SDMC Monthly Claim for Reimbursement - Treatment Cost.pdf 
• MC 1982 B: Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement - Administrative Cost:
• MC 1982B-1: SMHS Claims Before 9/30/2019 (88% MCHIP).xls
• MC 1982B-2: SMHS Claims From 10/1/2019 to 12/31/2019 (76.5% MCIHP).xls
• MC 1982B-3A: SMHS Claims From 1/2020 to 2/2020 (COVID – 80.84% MCHIP)
• MC 1982B-3B: SMHS Claims From 3/1/2020 to 3/31/2020 (COVID – 80.84%MCHIP)
• MC 1982B-4: Claims After 3/31/2020 (COVID – 80.84%, 30% OA)
• MC 1982B-5: Claims After 10/1/2020 (COVID 69.34%, 30% OA)
  
• MC 1982 C: SDMC Monthly Claim for Reimbursement - Quality Assurance/Utilization Review (QA/UR) Cost.xls
• MC 1982 D: SDMC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA).xls  
• MC 1982 G: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA).xls

County Interim Rate Table​

NOTE: To use the filter function in Excel, unprotect the worksheet and workbook. To unprotect, navigate to the "Review" tab in the Ribbon. In the "Changes" group, select "Protect Sheet" and "Protect Workbook."

• FY 2020-21 County Interim Rate Table.xlsm
  
• ​FY 2019-20 County Interim Rate Table.zip
  
• FY 2018-19 County Interim Rate Table.zip
  
• FY 2017-18 County Interim Rate Table.zip

EPSDT State General Fund (SGF) Payment Tables     

• FY 2010-11 EPSDT SGF County Ratios.pdf
• FY 2009-10 EPSDT SGF County Ratios.pdf
  

Katie A. Implementation

•  Katie A. Settlement Agreement Implementation homepage

Mental Health Provider Statement Information 

• Where to Download an MHP Statement.pdf 
  
• MHP Statement: A Sample.pdf                                                                                                                                           
  

References and Manuals

• Medicare Advantage Plans
• SDMC User Manual
• 837 Claim File Submission Validation (SR, TA1, 999).pdf
• ACA Information 
• Mental Health Medi-Cal Billing Manual (Rev. 10/13)​
• Mental Health Medi-Cal Billing Manual (Rev. 09/19)