Ca medical insurance

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Ca medical insurance

Telephone Service Center (TSC): 1-800-541-5555

Providers may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays. The TSC is staffed by knowledgeable telephone agents who can help providers understand the following:

Medi-Cal billing policies and procedures
Provider manual information
Correct completion of claims, Claims Inquiry Forms (CIFs), Appeal forms and Resubmission Turnaround Documents (RTDs)
Ordering forms and provider manuals

For faster access to TSC resources, refer to the guides for TSC Main Menu Prompt Options, AEVS Main Menu Prompt Options and the Provider Telecommunications Network (PTN) Main Menu Prompt Options. You are encouraged to print these guides and keep them next to your phone for easy reference.

One Number for Services and Help Desks In-state providers can dial 1-800-541-5555 for the following services and help desks (border providers and out-of-state billers billing for in-state providers, call [916] 636-1200):

Health Access Programs (HAP), California Children’s Services/Genetically Handicapped Persons Program (CCS/GHPP) and Other Specialty Programs

Questions about CCS/GHPP program benefits, policies, recipient information or enrollment of a CCS/GHPP-only provider should be directed to the appropriate CCS/GHPP office.

Point of Service (POS) Network, Internet, Lab Service Reservation System (LSRS), eTAR and Computer Media Claims (CMC) – The TSC provides technical support to providers using the POS network (which includes the telephone Automated Eligibility Verification System [AEVS], POS device and state-approved vendor software), Medi-Cal Web site, LSRS, eTAR and CMC. Pharmacy providers can obtain assistance with online claim submissions and answers to questions about adjudicated online pharmacy claims, pharmacy claim denial messages, Treatment Authorization Requests (TARs) and Drug Utilization Review (DUR) alerts. TSC agents can answer CMC billing questions and assist providers interested in automating their Medi-Cal billing processes.

Provider Telecommunications Network (PTN): 1-800-786-4346

The Provider Telecommunications Network (PTN) is an automated voice response service that allows providers to obtain checkwrite information, claim status or TAR status, continuing care, procedure, NDC or medical supply codes, general mailing information or forms and manual order information. Each active Medi-Cal provider has been assigned a unique Personal Identification Number (PIN) that may be entered using a touch-tone telephone to access the PTN. Providers may call the PTN at 1-800-786-4346 between 7 a.m. and 8 p.m., Pacific Standard Time, seven days a week. Refer to the Provider Telecommunications Network (PTN) section in your provider manual for PTN instructions.

Correspondence Specialist Unit

The Correspondence Specialist Unit (CSU) resolves complex billing issues. TSC agents may refer you to the CSU for inquiries that require additional research.

Providers may write directly to the Correspondence Specialist Unit (CSU) for clarification about recurring billing issues that have not been resolved through either the Claims Inquiry Form (CIF) or appeal process and have resulted in claim denials or potential unsatisfactory payments.

When writing to the CSU for assistance, providers should enclose up to three examples of Claim Control Numbers (CCNs) for the billing issue and include as much of the following documentation as possible with the letter of inquiry:

Legible claim form
Proof of eligibility, if date of service is beyond one year
Necessary documentation, operative report, invoice, etc.
Copies of all Remittance Advice Details (RAD)
Copies of all CIF acknowledgements, response letters
Copies of all Appeals acknowledgements, response letters
Copies of all dated correspondence from the previous/current Medi-Cal Fiscal Intermediary

A lack of necessary records may delay research.

Correspondence Specialists respond to providers either in writing or by telephone to clarify billing procedures. Letters to CSU should be addressed as follows:

California MMIS Fiscal Intermediary
Attn: CSU
P.O. Box 13029
Sacramento, CA 95813-4029

Cash Control Unit

The Cash Control Unit assists providers with questions regarding missing, lost or returned warrants, Remittance Advice Details (RADs), accounts receivable transactions, 1099s and provider refund checks. This unit also enrolls providers in electronic fund transfers (EFTs) and processes requests for Paid Claim Summary and Claims Detail reports.

Letters to the Cash Control Unit should be addressed as follows:

California MMIS Fiscal Intermediary
Attn: Cash Control
P.O. Box 13029
Sacramento, CA 95813-4029

Out-of-State Provider Unit: (916) 636-1960

The Out-of-State Provider Unit addresses the billing needs of non-California providers. California Code of Regulations (CCR), Title 22, Chapter 3, Article 1.3, Section 51006 allows reimbursement for medically necessary emergency services provided by an out-of-state provider to California Medicaid (Medi-Cal) recipients who are temporarily in another state. However, all providers must be enrolled in the Medi-Cal program before they can receive reimbursement.

To enroll as an out-of-state provider, you must complete the one-page Out-of-State Provider Express Enrollment form. This is the only form required for basic enrollment.

To learn more about the out-of-state provider program or to access links to other out-of-state provider forms and agreements, review the Out-of-State Providers Frequently Asked Questions (FAQs). These FAQs are a one-stop resource for out-of-state providers and can be printed for future reference.

If you are already familiar with the out-of-state provider program, you can access the other forms and agreements directly by clicking the following links. These are the same forms and agreements referenced in the FAQs.

If you have reviewed the FAQs and still have questions, call the Out-of-State Provider Unit at (916) 636-1960 from 8 a.m. to 12 p.m. and from 1 p.m. to 5 p.m., Monday through Friday, except holidays.

Small Provider Billing Unit: (916) 636-1275

The Small Provider Billing Unit (SPBU) is a FREE, full-service billing assistance and training program provided by the Department of Health Care Services (DHCS) and its Fiscal Intermediary (FI) . SPBU Claim Specialists and Regional Onsite Field Representatives work directly with providers in a structured program to assist in completing and submitting Medi-Cal claims. This detailed training program lasts one year.

Who Qualifies?
Provider participation is determined by DHCS. The SPBU program is designed to support Medical Services, Individual Nurse Provider (INP) and Adult Day Health Care providers. To qualify for SPBU assistance, a provider should be submitting less than 100 Medi-Cal claim lines per month and must not be conducting business with an outside billing service or agency.

Medical Service providers must bill the patient’s other coverage or Medicare prior to submitting claims to SPBU or Medi-Cal (except for wavier providers who do not have to bill the patient´s other coverage or Medi-Care prior to submitting claims to SPBU or Medi-Cal). Providers can bill by hard copy claims or submit claims electronically.

For more information, call (916) 636-1275 or 1-800-541-5555, ext. 1275. Representatives are available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.

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SOURCE: http://files.medi-cal.ca.gov/pubsdoco/contact/services.asp

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