Welcome New Medi-Cal Providers!
New Provider Checklist
The Department of Health Care Services (DHCS) thanks you for becoming a Medi-Cal provider and joining California’s network of comprehensive health care programs, which serves about 13 million Californians — forming the backbone of California’s health care safety net.
DHCS recommends all newly enrolled Medi-Cal fee-for-service providers use this step-by-step New Provider Checklist to help ensure success prior to submitting a claim for the first time. This checklist will highlight the critical areas and related services available to Medi-Cal providers.
Step 1 – Eligibility
- Read through the Electronic Methods for Eligibility Transactions and Claim Submissions (elect) manual section in the Part 1 provider manual.
- Read through the Share of Cost (share) manual section in the Part 1 provider manual.
- Review the TAR Authorization flyer which highlights services that require authorization.
Step 2 – Claim Forms and Claim Submission
- Utilize the Navigating Medi-Cal and Specialty Health Programs to determine which claim form(s) align to the benefits and services you will render and bill for monthly.
- Locate and become familiar with the specific Claim Form(s) you will utilize to bill Medi-Cal services each month.
- Review the Claim Submission and Follow-up Overview flyer for claim timelines and additional submission resources.
- Review Billing Tips for important and initial Medi-Cal billing information.
Step 3 – Electronic Billing
- Read through the Electronic Billing flyer.
- Access the Computer Media Claims (CMC) Submission Instructions for online billing instructions.
Step 4 – Timeliness and Checkwrite Schedule
- Refer to the Medi-Cal Claims Timeliness Chart for claims submission timelines.
- Refer to the Checkwrite Schedule located within the Checkwrite section (check) of the Part 1 provider manual for the current year’s schedule.
Step 5 – Transaction Services
- Review the specific Transaction Enrollment Requirements for Medi-Cal Internet Transactions.
- Review the list of Transaction Services Available within Medi-Cal Internet Transactions.
- Access Medi-Cal Transactions via the tile located on the Medi-Cal Provider home page OR by navigating to: Providers Tab > Transactions
Step 6 – General Resources
- View the Navigating Medi-Cal and Specialty Health Programs and identify the provider communities that you will render benefits and services to.
- Take the Medi-Cal Website Tour.
- Visit the Medi-Cal Provider Publications page. Then proceed to your specific provider community page(s). It is recommended that you bookmark these pages for quick and easy access.
Note: Within these provider community pages, you will find Medi-Cal News, monthly Medi-Cal Update Bulletins, Provider Manuals and Featured Links to additional key areas such as Billing Tips, Medi-Cal Rates and References.
- Sign up for the free and easy Medi-Cal Subscription Service (MCSS) to receive tailored Medi-Cal news, bulletins and more based on your specific provider communities. The Medi-Cal Subscription Service (MCSS) Help page details answers to questions that you might have about MCSS.
Step 7 – Outreach, Education and Provider Training
- Visit the Medi-Cal Learning Portal (MLP) which can be accessed on the MLP tile located at the bottom of the Medi-Cal Provider home page OR by navigating to:
Providers Tab > Outreach & Education > Launch the Medi-Cal Learning Portal (MLP)
- Create and register for an MLP account.
- Take the Medi-Cal Resources 101 training.
- View the Provider Training Webinars and Seminars Calendar. Note when a Medi-Cal Provider seminar is coming to a city near you and register online to attend.
Note: Seminars are offered 10 times each year across the State of California.
- Contact Medi-Cal via the Telephone Service Center (TSC) at 1-800-541-5555 and schedule your first on-site visit with your specific area’s Regional Representative. TSC is also available to assist providers with general inquiries.
Note: If you are a provider billing “fewer than 100 claim lines per month,” consider enrolling in the Small Provider Billing Assistance and Training Program offered by the Small Provider Billing Unit.
Step 8 – Frequently Asked Questions (FAQs)
- Visit the FAQs web page for helpful answers to questions on a wide variety of topics.
- Read through each of the materials linked below.