Section 3: Claims

​​Table of Contents - Medi-Cal

 

PHC is a Medi-Cal Managed Care Healthplan.  PHC Claims Department follows State of California Medi-Cal Provider Manual unless otherwise stated here in the PHC Medi-Cal Claims Manual.

Procedure

Counties and Services Covered by PHC

Where to Submit Medi-Cal Claims

Required Medi-Cal Billing Forms and Completion Requirements

 

Medi-Cal CMS 1500

 

Medi-Cal UB-04

 

Medi-Cal LTC Billing Form

 

Medi-Cal CHDP PM160 Information Only Form

 

Medi-Cal Modifiers List
        1. Approved Modifiers
        2. Modifiers Used with Procedure Codes

 

PHC Medi-Cal Claim Billing Limit

Electronic Medi-Cal Claim Submission

 

PHC Medi-Cal Encounter Data Submission

 

PHC Medi-Cal Electronic Claims Submission 

 

Medicare Part B Electronic Crossover Claims

Required Medi-Cal Claim Attachments, Supplemental Information and Documentation

PHC Medi-Cal Reimbursement

 

PHC Medi-Cal Rates

 

PHC Medi-Cal Check Run Schedule 

 

PHC Medi-Cal Provider Payment Documentation
        1. PHC Medi-Cal RAs       
        2. PHC Medi-Cal Pend Reports      
        3. PHC Medi-Cal Electronic 835
        4. PHC Medi-Cal Electronic 277

 

Prohibition Against Balance Billing PHC Members for Covered Services   
        1. Medi-Cal PCP Contracts
        2. Medi-Cal Specialist and Ancillary Contracts
        3. Medi-Cal Hospital Contracts
        4. Medi-Cal Title 22 Beneficiary Billing

 

PHC Medi-Cal Claims Inquiries

 

PHC Medi-Cal Telephone Inquiries

 

PHC Medi-Cal e-Claim Inquiries

PHC Medi-Cal Provider Appeal Process (CIF and Appeal Timelines)

 

First Level Appeal – PHC Medi-Cal Claims Inquiry Form Process
            1. Electronic Claims Inquiry Form System (e-CIF)

 

Second Level Appeal  – PHC Medi-Cal Claims Appeal (Medi-Cal Appeal Form)

Important Medi-Cal Provider Notices

PHC Medi-Cal Claims Policies/Billing Guidelines

 

Anesthesia Services

 

Authorization Requirements

 

Child Health and Disability Prevention Program (CHDP)

 

Circumcisions

 

Community Based Adult Services (CBAS)

 

Comprehensive Perinatal Services Program (CPSP Services)

 

Evaluation and Management Services (E&M)

 

Family Planning Services

 

Injectibles
              1. Flu Vaccine

Inpatient Hospital

 

Laboratory Services

 

Mental Health Services

 

National Drug Code (NDC)

Newborn Services

 

Obstetrical Services

 

Other Primary Coverage

Screening for Lung Cancer

 

Third Party Liability and Worker’s Compensation

 

Vision Services 

​​Please Direct Questions To:

Partnership HealthPlan of California

4665 Business Center Drive

Fairfield, CA 94534

Phone: (707) 863-4100