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