For Medi-Cal Providers
This page provides information and resources about how to enroll to become a Medi-Cal provider, provider billing and claim assistance, and Medi-Cal covered benefits, including coverage policies.
Medi-Cal Provider Enrollment
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 is also responsible for developing enrollment policy, and updating and maintaining provider information in the Provider Master File database that is used in the claims payment process.
Medi-Cal providers can learn more about DHCS/PED, or contact them directly.
Medi-Cal Provider Manual and Provider Bulletins
Medi-Cal providers have access to the Medi-Cal Provider Manual and Provider Bulletins, which outline Medi-Cal coverage and reimbursement policy.
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 Provider Billing and Claim Assistance
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 providers can contact the Telephone Service Center (TSC) by phone at (800) 541-5555 (outside of California, (916) 636-1980), Monday through Friday, except holidays, from 8:00 a.m. to 5:00 p.m. For faster access to TSC resources, Medi-Cal providers can refer to the TSC Main Menu Prompt Options Guide.
Through the Small Provider Billing Unit, DHCS also offers a full-service billing assistance and training program for Medi-Cal providers who submit up to 100 Medi-Cal claims per month and do not use a billing service or agency. Medi-Cal providers can contact the Small Provider Billing Unit by phone at 916) 636-1275, Monday through Friday, except holidays, from 8:00 a.m. to 12:00 p.m. and from 1:00 p.m. to 5:00 p.m.
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 Provider Training
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.
Additionally, the Medi-Cal Learning Portal offers Medi-Cal providers and billers self-paced online training about billing basics, policies, procedures, new initiatives and upcoming changes to the Medi-Cal program.
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.
Medi-Cal Benefits
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]
