Conlan Frequently Asked Questions
Return to the Medi-Cal Out-of-Pocket Expense Reimbursement (Conlan) webpage
How do I know if I am eligible to receive Medi-Cal out-of-pocket expense reimbursement through Conlan?
If you have Medi-Cal (Fee for Service), and you paid out of pocket for services rendered for a Medi-Cal and/or dental provider, you are entitled to submit a Conlan Reimbursement Claim Packet to get reimbursed (some restrictions apply). If you have additional questions you can visit the Medi-Cal Conlan webpage.
What services are covered?
Any service that can be found under the CPT Codes (Current Procedural Terminology) that include Medical, Surgical and Diagnostic services.
Can I be reimbursed for medical expenses prior to becoming eligible for Medi-Cal?
Yes, you may be reimbursed for Retro Active Medi-Cal expenses up to three months from the date you applied for Medi-Cal. For further information, please contact your local County office.
How do I submit a claim and get reimbursed?
You can call the Conlan phone line at (916) 403-2007 to request a reimbursement packet. You would then mail it to the address provided in the packet.
Can I fill out an application on my own?
To receive a Conlan claim packet to request reimbursement (refund) from Medi-Cal program for medical, pharmacy and/or dental expenses paid, either the BSC can mail a packet to you ot, if you prefer, fill out the required documents online, print them, and then mail the completed forms to the BSC as per online instructions.
The online forms are located on the Online Conlan Claim Forms webpage.
Is there a limit on the amount of reimbursement?
No, there is no limit.
What proof do I need to provide to be reimbursed?
The Claim Form must include:
- A photocopy of your Medi-Cal Beneficiary Identification Card (BIC).
- Medi-Cal Claim for Beneficiary Reimbursement.
- Proof of payment - Examples include a copy of a cancelled check(s) from the bank (front and back), receipt(s) from the provider you paid, evidence of electronic payment, or a copy of a money order. A declaration may be used in some situations to explain, supplement, or support the documents above.
- A completed PAYEE DATA RECORD Form.
- For those services that would have required Medi-Cal Authorization, documentation from the medical or dental provider that shows the medical necessity for the service.
- An itemized billing statement indicating the date(s) of service; and the service(s) and/or service code(s) for which you paid out-of-pocket to the provider(s).
Can I appeal if any portion of my request for reimbursement is denied?
You have a right to ask for a State Hearing about this Medi-Cal action (California Code of Regulations, Title 22, Section 50951). You must ask for a State Hearing within 90 days of the date the denial or payment notice was mailed to you.
Who do I contact if I need more information or assistance?
You can call the Conlan phone line at (916) 403-2007 for further assistance.
Where can I find more information on the Conlan v. Shewry court ordered plan?
You can find additional information on the DHCS website on the APL 2007 webpage.
Can I submit a claim if my Provider is not a Medi-Cal Provider?
Yes, you can submit a claim if your provider is not a Medi-Cal provider, but you may not receive a full reimbursement.
Can I submit a claim without a Social Security Number?
Yes, you can submit a claim without a Social Security Number (SSN). If you do not have a SSN you can submit your Tax Identification Number (TIN). If you are not able to provide a SSN or TIN and the provider does not voluntarily refund you, the payment will not be processed.
Can I be reimbursed for premiums for my private health insurance?
No, premiums are not a Medi-Cal covered benefit.
If I no longer have Medi-Cal can I still submit my claim for reimbursement?
Yes, as long as you were covered on the date of service(s) by Medi-Cal.
If I'm out of state and received medical assistance, can I submit my claim for reimbursement?
Yes, for emergency and life-threatening services, as described per Medi-Cal Guidelines.
Who should I contact about an IHSS claim?
You can contact the Beneficiary Service Center (BSC) at (916) 403-2007 and for IHS at 1 (877) 508-1327.
Who should I contact about dental reimbursements?
You can contact the Beneficiary Service Center (BSC) at (916) 403-2007, option 4.
How long does a reimbursement take to be processed?
A claim should be processed for reimbursement within 120 days from the date a claim is complete and valid.
How long does it take the check to get mailed?
Once the claim is approved, the provider is sent a letter to reimburse the beneficiary and has 30 days to respond. If the provider does not respond within 30 days, the check will be mailed out between 7-8 weeks. Note: This does not include mail time.
Will the check be mailed in the authorized representative's name?
No, the check will be sent with the beneficiary's name.
Who fills out the Payee Data Record (PDR)?
The beneficiary should be the one to fill out the Payee Data Record. Note: if the beneficiary is a minor the parent would be the one to fill out the Payee Data Record.
How do you fill out the Payee Data Record (PDR)?
- Write your (beneficiary's) name on the line labeled: "BENEFICIARY/SOLE PROPIETOR."
- Write your mailing address below your name on the lines provided.
- Check the box labeled: INDIVIDUAL OR SOLE PROPIERTOR." Write your (beneficiary's) 9-digit social security number in the spaces provided (If no social security - include I ETIN).
- Check the box labeled: California resident - qualified to do business in California or maintains a permanent place of business in California."
- Sign or write your name in the line labeled: "Signature." Write the date you signed the form and write your phone number on the lines provided (If you are the beneficiary's authorized payee representative type or print your name in the Authorized Payee Representatives Name field".
- Do not write in this section. This section is for official use only. This section must be completed by the State agency.
How long does a beneficiary have to submit a reimbursement?
Beneficiary claim packet must be received within one year from the date of service or 90 days from the date of when beneficiary's Medi-Cal card was issued, whichever is later.
Can a packet be sent without having a Benefit Identification Card (BIC) or to someone other than a beneficiary?
Yes, a packet can be sent without a BIC or to a representative calling on behalf of the beneficiary. Note: When the form is filled out it should be completed with the members information.
How do I check the status of the reimbursement claim?
Please contact the Call Center-Beneficiary Service Center at (916) 403-2007. After your call is answered, provide the Conlan Case Number you received and/or your Beneficiary Identification Card number and ask for your claim status. The agent will gladly provide the information to you.
What is required to approve a MC 220 or MC 382 form?
If a beneficiary:
- Is able to sign, then both (MC 220 and MC382) forms should be fully completed and mailed in.
- Is unable to sign, then only the Power of Attorney (POA) is required to be sent. Note: In event of a beneficiary has passed away, we would need the POA and the death certificate.
If a beneficiary has a Managed Care Plan (MCP) can I still send a packet?
Yes, if a beneficiary has a MCP the Conlan team would make sure the packet is fully completed. The Conlan the analyst would refer the case to the MCP.
What is Explanation of Medicare Benefits (EOMB)?
If an explanation of Benefits from Medicare (EOMB) is needed for date(s) of service rendered, the Conlan team verifies payment(s) or denial(s) Medicare has made to provider.
Note: This can be obtained by calling Medicare at (800) 633-4227.
