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.


Counties and Services Covered by PHC

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


PHC Medi-Cal Claim Billing Limit


1. Medi-Cal Billing Limit
2. Wellness & Recovery 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)

(End dated December 31, 2023) 


Second Level Appeal  – PHC 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

PHC Medi-Cal Claims Policies/Billing Guidelines

​340B Billing Information


Anesthesia Services


Authorization Requirements

Child Health and Disability Prevention Program (CHDP)    (End dated 6/30/17)                      See Preventtive Services below for DOS on or after 7/1/17




Community Based Adult Services (CBAS)


Comprehensive Perinatal Services Program (CPSP Services)


Evaluation and Management Services (E&M)


Family Planning Services


              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