Section 3: Claims

​​Table of Contents - Medi-Cal

 

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

Procedure

Counties and Services Covered by Partnership

Medi-Cal Counties & Services Covered
Wellness & Recovery Counties and Services Covered

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

 

Partnership Medi-Cal Claim Billing Limit

1. Medi-Cal Billing Limit

2. Wellness & Recovery Billing Limit 

Electronic Medi-Cal Claim Submission

 

Partnership Medi-Cal Encounter Data Submission

 

Partnership Medi-Cal Electronic Claims Submission

 

Medicare Part B Electronic Crossover Claims

Required Medi-Cal Claim Attachments, Supplemental Information and Documentation

Partnership Medi-Cal Reimbursement

 

Partnership Medi-Cal Rates

 

Partnership Medi-Cal Check Run Schedule

 

Partnership Medi-Cal Provider Payment Documentation

1. Partnership Medi-Cal RAs

2. Partnership Medi-Cal Pend Reports

3. Partnership Medi-Cal Electronic 835

4. Partnership Medi-Cal Electronic 277

 

Prohibition Against Balance Billing Partnership 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

Partnership Medi-Cal Claims Inquiries

 

Partnership Medi-Cal Telephone Inquiries

 

Partnership Medi-Cal e-Claim Inquiries

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

 

First Level Appeal – Partnership Medi-Cal Claims Inquiry Form Process

1. Electronic Claims Inquiry Form System (e-CIF)

(End dated December 31, 2023) 

 

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

(End dated December 31, 2023)


Provider Claims Dispute Resolution Mechanism (Effective January 1, 2024) 

​Provider Claims Dispute Resolution Form (Effective January 1, 2024) 

Important Medi-Cal Provider Notices

Partnership Medi-Cal Claims Policies/Billing Guidelines


​340B Billing Information

 

Anesthesia Services

 

Authorization Requirements


Child Health and Disability Prevention Program (CHDP) 

(End dated June 30, 2017)

See Preventive Services below for DOS on or after July 1, 2017

 

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

Long Term Care (LTC) Rate Updates

 

Mental Health Services

 

National Drug Code (NDC)

Newborn Services

 

Obstetrical Services

 

Other Primary Coverage

​Pay On Behalf of Delegated Entity

A. Pay on Behalf Claims Inquiry and Dispute Resolution Process

Preventive Services (Formerly CHDP)

Radiology Services

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