Contents

PART 1 – MEDI-CAL PROGRAM AND ELIGIBILITY

The Contents is a list of manual sections contained in Part 1 – Medi-Cal Program andEligibility. Section titles appear in alphabetical order. The “locator key” is an abbreviated form of the section title at the top of each page for skimming and identifying sections. For detailed topic entries within Part 1 and Part 2, refer to the Manual Index in the Indexes and Glossary manual.

Section Title Locator Key

A

AEVS: General Instructions...... aev gen

AEVS: Other Health Coverage (OHC) Carrier Codes...... aev ohc car

access on Internet at

AEVS: Transactions...... aev trn

Automated Eligibility Verification System (AEVS) Response Log (form)

AEVS: Transactions – SOFP...... aev trn sofp

Aid Codes Master Chart...... aid codes

Appeal Process Overview...... appeal

C

Checkwrite...... check

CIF Overview...... cif

Claim Payment Flowchart...... claim pay

Claim Submission and Timeliness Overview...... claim sub

CMC...... cmc

CMC Developers, Vendors and Billing Service Directory...... cmc dir

access on Internet at

CMC Enrollment Procedures...... cmc enroll

CMC Enrollment Checklist

Medi-Cal Telecommunications Provider and Biller Application/Agreement (form)

CHDP Telecommunications Provider and Biller Application/Agreement (form)

County Medical Services Program (CMSP)...... county med

1 – Contents for Medi-Cal Program and Eligibility 1

March 2010

Contents

PART 1 – MEDI-CAL PROGRAM AND ELIGIBILITY

Section Title Locator Key

E

Electronic Fund Transfer...... eft

Electronic Fund Transfer Authorization (form)

Electronic Methods for Eligibility Transactions and Claim Submissions...... elect

Eligibility: Recipient Identification...... elig rec

Eligibility: Recipient Identification Cards...... elig rec crd

Eligibility: Service Restrictions...... elig rstrict

Eligibility: Special Groups...... elig special

H

Health Access Programs (HAP)...... health acces

M

MCP: An Overview of Managed Care Plans...... mcp an over

MCP: Code Directory...... mcp code dir

MCP: County Organized Health System (COHS)...... mcp cohs

MCP: Geographic Managed Care (GMC)...... mcp gmc

MCP: Imperial, San Benito and Regional Models...... mcp imperial

MCP: Primary Care Case Management (PCCM)...... mcp prim

MCP: Special Projects...... mcp spec

MCP: Two-Plan Model...... mcp two plan

Medicare/Medi-Cal Crossover Claims Overview...... medicare

1 – Contents for Medi-Cal Program and Eligibility 1

March 2010

Section Title Locator Key

O

OBRA and IRCA...... obra

Other Health Coverage (OHC) Guidelines for Billing...... other guide

P

Percent Programs...... percent

Point of Service (POS)...... point

Medi-Cal Eligibility Verification Enrollment Form

Medi-Cal Point of Service (POS) Network/Internet Agreement (form)

Point of Service (POS) Device Usage Agreement (form)

Procedure/Drug Code Limitation List Introduction...... proc intro

access on Internet at

Procedure/Drug Code Limitation List...... proc list

access on Internet at

Programs Overview...... prog

Provider Guidelines...... prov guide

Provider: Medi-Cal Hardcopy Biller Notification Form

Biller: Medi-Cal Hardcopy Biller Application Agreement (form)

Provider Guidelines: Billing Compliance...... prov guide bil

Provider Regulations...... prov reg

Provider Relations Directory...... prov rel

Provider Telecommunications Network (PTN)...... prov tele

1 – Contents for Medi-Cal Program and Eligibility iii

August 2017

Section Title Locator Key

R

Remittance Advice Details (RAD) and Medi-Cal Financial Summary...... remit

Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment...... remit and

Remittance Advice Details (RAD) Codes and Messages: 001 – 099...... remit cd001

Remittance Advice Details (RAD) Codes and Messages: 100 – 199...... remit cd100

Remittance Advice Details (RAD) Codes and Messages: 200 – 299...... remit cd200

Remittance Advice Details (RAD) Codes and Messages: 300 – 399...... remit cd300

Remittance Advice Details (RAD) Codes and Messages: 400 – 499...... remit cd400

Remittance Advice Details (RAD) Codes and Messages: 500 – 599...... remit cd500

Remittance Advice Details (RAD) Codes and Messages: 600 – 699...... remit cd600

Remittance Advice Details (RAD) Codes and Messages: 700 – 799...... remit cd700

Remittance Advice Details (RAD) Codes and Messages: 800 – 899...... remit cd800

Remittance Advice Details (RAD) Codes and Messages: 900 – 999...... remit cd900

Remittance Advice Details (RAD) Codes and Messages: 1800 – 1899.....remit cd1800

Remittance Advice Details (RAD) Codes and Messages: 9000 – 9999.....remit cd9000

Remittance Advice Details (RAD): Electronic...... remit elect

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 001 – 099...... remit elect corr001

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 100 – 199...... remit elect corr100

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 200 – 299...... remit elect corr200

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 300 – 399...... remit elect corr300

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 400 – 499...... remit elect corr400

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 500 – 599...... remit elect corr500

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 600 – 699...... remit elect corr600

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 700 – 799...... remit elect corr700

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 800 – 899...... remit elect corr800

1 – Contents for Medi-Cal Program and Eligibility iii

August 2017

Section Title Locator Key

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 1800 – 1899...... remit elect corr1800

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9000 – 9099...... remit elect corr9000

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9100 – 9199...... remit elect corr9100

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9200 – 9299...... remit elect corr9200

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9500 – 9599...... remit elect corr9500

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9600 – 9699...... remit elect corr9600

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9700 – 9799...... remit elect corr9700

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9800 – 9899...... remit elect corr9800

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: 9900 – 9999...... remit elect corr9900

Remittance Advice Details (RAD) Electronic Correlation Table

to National Codes: HCRC to RAD...... remit elect corr hcrc

S

Share of Cost (SOC)...... share

Suspended and Ineligible Provider List Introduction (Medi-Cal)...... sus intro

access on Internet at

Suspended and Ineligible Provider List (Medi-Cal)...... susp

access on Internet at

T

TAR Overview...... tar

1 – Contents for Medi-Cal Program and Eligibility v

August 2018