navigating medi-cal and specialty health...
TRANSCRIPT
Long Term Care (LTC)
LTC25-1 claim form
AIDS Waiver ProgramCommunity-Based Adult Services (formerly ADHC)Expanded Access to Primary Care (EAPC)Home Health Agencies/Home and Community-Based ServicesLocal Educational Agency (LEA)Multipurpose Senior Services Program
OUTPATIENT
HOME & COMMUNITYUB-04 claim form
AIDS Waiver ProgramChronic Dialysis Clinics Clinics and Hospitals Federally Qualified Health Centers (FQHC) Heroin DetoxificationHospice Care ProgramIndian Health Services (IHS)Inpatient ServicesRehabilitation ClinicsRural Health Clinics (RHC)
INPATIENT/OUTPATIENT
INSTITUTIONALUB-04 claim form
Vision Care
VISION CARE
Pharmacy (PH) SuppliesPharmacy 30-1 and 30-4 claim forms
PHARMACY
MEDICAL SERVICES
General Medicine (GM)Obstetrics (OB)
AcupunctureAudiology and Hearing AidsChiropracticDurable Medical Equipment and Medical Supplies (DME)Medical TransportationOrthotics and ProstheticsPsychological ServicesTherapies
ALLIED HEALTH
PROFESSIONALCMS-1500 claim form
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PM160 ‡ CMS-1500 UB-04 30-1/30-4MEDI-CAL SPECIALTY PROGRAMSComprehensive Perinatal Services Program (CPSP)**Every Woman Counts (EWC)** Presumptive Eligibility for Pregnant Women (PE4PW)**OTHER SPECIALTY PROGRAMSCalifornia Children’s Services (CCS)Child Health and Disability Prevention (CHDP)Family Planning, Access, Care and Treatment (Family PACT)**Genetically Handicapped Persons Program (GHPP)
SPECIALTY PROGRAMS
** Health Access Program (HAP) ‡ End Date 11/1/18
Child Health Disability Program (CHDP) PM 160 Claim FormCalifornia Children's Services (CCS)Genetically Handicapped Persons Program (GHPP )
SPECIALITY PROGRAMSXXXXX Claim Form
Navigating Medi-Cal and Specialty Health Programs
Use this chart to help you navigate the Medi-Cal LearningPortal (https://learn.medi-cal.ca.gov), understand theMedi-Cal or specialty provider manual you reference forpolicy and billing instructions (for example, the Allied Healthfor Therapies manual) and identify the claim form youuse when billing for services rendered.