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  • Orthotic and Prosthetic Appliances and Services (ortho) - Medi-Cal
    For purposes of authorization and reimbursement of O P appliances and services, recipient’s eligible for the following programs must access services available under these programs prior to receiving services under the Medi-Cal program
  • Other Health Coverage (OHC) Guidelines for Billing (other guide) - Medi-Cal
    Billing OHC Before Medi-Cal In most situations, providers are required by law to exhaust the recipient’s OHC before billing Medi-Cal In those situations where OHC utilization is not required before billing Medi-Cal, providers are still encouraged to bill OHC first
  • DHCS - Provider Portal
    State of California
  • Medi-Cal Providers
    The Medi-Cal Providers website provides access to Medi-Cal billing support services and to perform secure Medi-Cal Fee-for-Service and other associated health care program claims and transactions Medi-Cal providers, submitters and other intermediaries may login to the Provider Portal
  • Prescription Referrals (prescript)
    This section describes prescription requirements for therapeutic services, orthotic and prosthetic (O P) appliances and Durable Medical Equipment (DME) rentals and purchases
  • Medicare Medi-Cal Crossover Claims: Outpatient Services
    If only Medicare and Medi-Cal are involved, enter “MEDICARE” on line A and “O P MEDI-CAL” on line B Enter the facility type as the first two digits in the Type of Bill field (Box 4)
  • Criteria for Authorization and Reimbursement – Orthotics - Medi-Cal
    The criteria for authorization and reimbursement listed in this section refer only to those HCPCS codes that are Medi-Cal benefits ‹‹Reimbursable orthotic HCPCS codes are listed in the Orthotic and Prosthetic Appliances: Billing Codes – Orthotics section of this manual ››
  • Medicare Medi-Cal Crossover Claims: UB-04
    If only Medicare and Medi-Cal are involved, enter “MEDICARE” on line A and “O P MEDI-CAL” on line B Enter the facility type as the first two digits in the Type of Bill field (Box 4)
  • Supplies and Drugs Billing Examples: UB-04 (supp drug bil) - Medi-Cal
    Enter “O P Medi-Cal” to indicate the type of claim and payer in the Payer Name field (Box 50) The facility’s provider number is placed in the NPI field (Box 56)
  • UB-04 Submission and Timeliness Instructions (ub sub) - Medi-Cal
    For more information regarding attachment submissions, refer to the billing instructions in the HIPPA 5010 Medi-Cal Companion Guide This guide is available under the Technical Specifications heading on the HIPAA: 5010 NCPDP D 0 1 2 page of the Medi-Cal website (www medi-cal ca gov)





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