Medi-Cal
The Medi-Cal Telephone Service Center (TSC) toll-free number is 1-800-541-5555. TSC is available 8 a.m. to 5 p.m., Monday through Friday, except holidays. For border providers and out-of-state billers billing for in-state providers, please call (916) 636-1200.
Bulletins - Providers can access bulletin updates about Part 1 Medi-Cal Programs and Eligibility, Psychological Services, ADHC, Clinics and Hospitals, EAPC, General Medicine, Pharmacy, CHDP and Family PACT.
Medi-Cal Subscription Service - The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website.
Manuals - The manual is divided into two parts, Part 1 (Program & Eligibility) and Part 2 (Billing and Policy). There is also a Specialty Program Manual that works with Medi-Cal Parts 1 and 2 manual.
Part 1– Medi-Cal Program and Eligibility - is a general reference that applies to all Medi-Cal providers. It offers an orientation to Medi-Cal services, programs, claim reimbursement and complete information about recipient eligibility and provider participation. Overview sections in Part 1 generally correlates to the more detailed Part 2 sections of the manual.
Part 2 – Medi-Cal Billing and Policy - is a custom manual for day-to-day use that is divided among various topics, i.e. Allied Health, Inpatient/Outpatient, Long Term Care, Medical Services, Pharmacy, Vision Care, Specialty Programs, and Other Sections. It contains specific program policies, code lists, claim form and follow-up instructions pertaining to your provider community.
Specialty Program Manuals - such as the CHDP Provider Manua l and the Family PACT Policies, Procedures and Billing Instructions manual, work together with Medi-Cal Part 1 and 2 manuals. It refers to specific program policy, eligibility requirements, code lists and claim form completion instructions that is relevant to each specialty program.
Training Seminars and Tools
Medi-Cal Education & Outreach provides a variety of support services to help providers bill Medi-Cal and other programs, assist in claims troubleshooting, and clarify the reimbursement process.
Medicare
CMS Medicare Administrative Contractor (MAC) – A MAC is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. California currently has two different MACs who process claims and provide training.
Noridian MAC
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A/B MAC Jurisdiction E
1-855-609-9960
CA, HI, NV, American Samoa, Guam, Northern Mariana Islands
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1-855-609-9960
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DME MAC Jurisdiction D
AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, American Samoa, Guam, Northern Mariana Islands |
1-877-320-0390 |
National Government Services (NGS) MAC
CPCA Staff Contact
Elle Grant, Senior Program Coordinator, Licensing & Provider Enrollment
egrant@cpca.org
(916) 440-8170