Medi-Cal Resources for California
What is Medicaid?
1. A federally aided, state-operated, and state-administered program for low-income persons in need of health care benefits established by Title 19 of Social Security Act. 2. Administered by each state with partial federal funding. 3 Each state operated a children's health insurance program. 4 Some federal acts allow assistance of Qualified Medicare Beneficiaries (QMBs) and Specified Low Income Medicare Beneficiaries (SLMBs). 5 May or may not pay for deductible, copays, or share cost. 6 Providers must enroll for participation in the Medicaid program with the fiscal agent or local public service welfare office. 7 Medicaid ID cards are issued monthly. 8 Prior approval is required for medical services. Some patients may have retroactive eligibility. 9 CMS-1500 form used for claim submission in all states. Treatment Authorization Request (TAR)
Get information on how the Treatment Authorization Request are processed. Requirements are applied to specific procedures and services according to State and Federal law. Certain procedures and services are subject to authorization by Medi-Cal field offices before reimbursement can be approved. All inpatient hospital stays require authorization. For more information, select a topic. Providers must receive authorization from Medi-Cal in order to provide and/or be paid for some of these services. The form a provider uses to request authorization is called a Treatment Authorization Request (TAR). Provider Enrollment Division (PED)
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. Requirements for newly certifying or enrolling, enrollment at a new location or a change in
location, and for revalidating DMC providers Effective October 24, 2014, a DMC Provider Agreement (DHCS 6009) is required each time an application package is submitted to DHCS for new certification or enrollment, enrollment at a new location or a change of location and revalidation in the DMC program. A DMC provider agreement is required for each separate business location where an applicant or provider is certified to participate in Medi-Cal. |
Useful Links
CA.gov - Medi-Cal Medi-Cal EHR Incentive Medi-Cal News Articles DMC Provider Agreement Claim Form Updates |