Para sa Mga Provider ng Medi-Cal
Ang pahinang ito ay nagbibigay ng impormasyon at mga mapagkukunan tungkol sa kung paano magpatala upang maging isang provider ng Medi-Cal, tulong sa pagsingil at pag-claim ng provider, at mga benepisyong sakop ng Medi-Cal, kabilang ang mga patakaran sa saklaw.
Pagpapatala ng Tagapagbigay ng Medi-Cal
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.
Responsable din ang DHCS/PED sa pagbuo ng patakaran sa pagpapatala, at pag-update at pagpapanatili ng impormasyon ng provider sa database ng Provider Master File na ginagamit sa proseso ng pagbabayad ng mga claim.
Medi-Cal providers can learn more about DHCS/PED, or contact them directly.
Manwal ng Provider ng Medi-Cal at Mga Bulletin ng Provider
Ang mga provider ng Medi-Cal ay may access sa Medi-Cal Provider Manual at Provider Bulletin, na nagbabalangkas sa Medi-Cal coverage at 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.
Tulong sa Pagsingil at Pag-claim ng Provider ng Medi-Cal
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).
Maaaring makipag-ugnayan ang mga provider ng Medi-Cal sa Telephone Service Center (TSC) sa pamamagitan ng telepono sa (800) 541-5555 (sa labas ng California, (916) 636-1980), Lunes hanggang Biyernes, maliban sa mga holiday, mula 8:00 am hanggang 5:00 pm Para sa mas mabilis na pag-access sa mga mapagkukunan ng TSC, maaaring sumangguni ang mga provider ng Medi-Cal sa TSC Main Menu Prompt Options Guide.
Sa pamamagitan ng Small Provider Billing Unit, nag-aalok din ang DHCS ng full-service na tulong sa pagsingil at programa sa pagsasanay para sa mga provider ng Medi-Cal na nagsusumite ng hanggang 100 Medi-Cal na claim bawat buwan at hindi gumagamit ng serbisyo sa pagsingil o ahensya. Maaaring makipag-ugnayan ang mga provider ng Medi-Cal sa Small Provider Billing Unit sa pamamagitan ng telepono sa 916) 636-1275, Lunes hanggang Biyernes, maliban sa mga holiday, mula 8:00 am hanggang 12:00 pm at mula 1:00 pm hanggang 5:00 pm
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.
Pagsasanay sa Provider ng Medi-Cal
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.
Dagdag pa rito, ang Medi-Cal Learning Portal ay nag-aalok ng Medi-Cal provider at biller na self-paced online na pagsasanay tungkol sa mga pangunahing kaalaman sa pagsingil, mga patakaran, pamamaraan, mga bagong hakbangin at paparating na mga pagbabago sa programa ng Medi-Cal.
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 (Hindi 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.
Mga Benepisyo ng Medi-Cal
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]