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.
Reproductive Health Hotline (Not DHCS)
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 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]
