Medi-Cal provides free or low-cost health coverage to eligible Californians, including services like vision, dental care, mental health treatment, and prescriptions.

State of California

Oct 10, 2024 · WARNING: This computer system is for official use by authorized users and may be monitored and/or restricted at any time. Confidential information may not be accessed or used without authorization. Unauthorized or improper use of this system may result in administrative discipline, civil and/or criminal penalties.

Note: When billing Medicare for Medi-Cal medical supply crossover claims, providers should not include the Universal Product Number (UPN), qualifier, unit of measurement qualifier and UPN units.

Request (TAR) documenting the medical necessity. For more information, refer to the Treatment Authorization Request (TAR) section in this manual. There is client-centered health education and counseling throughout all of these services.

Sacramento, CA 95852-1700 372 This crossover must be billed with line-specific information. Please resubmit with line item information. 395† This is a Medicare non-covered benefit.

cif 1 Part 1 – CIF Overview CIF Overview Page updated: November 2021 The Claims Inquiry Form (CIF) is used after submitting a claim to request one of the following: • Adjustment – A claim has been paid at a different amount from the expected Medi-Cal

medi cr op ex 17 Part 2 – Medicare/Medi-Cal Crossover Claims: Outpatient Services Billing Examples Page updated: August 2020 ‹‹Legend›› ‹‹Symbols used in the document above are explained in the following table.››

cms sub 2 Part 2 – CMS-1500 Submission and Timeliness Instructions Page updated: February 2022 Late Billing Instructions Follow the steps below to bill a late claim that meets one of the approved delay reasons:

Most medical supplies are not covered by Medicare and can be billed directly to Medi-Cal. However, the medical supplies listed in the Medical Supplies: Medicare-Covered Services section of the appropriate Part 2 manual are covered by Medicare and must be billed to