Claims

Medi-Cal Learning Portal

The Medi-Cal Learning Portal provides extensive resources and a broad range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link (By clicking on this link, you will be leaving the IEHP website) https://learn.medi-cal.ca.gov/.

Medi-Cal Rates and Codes

By clicking on these links, you will be leaving the IEHP website.

 

Medi-Cal Rates

The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system.

Resource: website

 

CPT Codes

This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits.

Resource: website

 

Alpha-Numeric HCPCS Files

These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.

Resource: website

 

ZIP code To Carrier Locality File

This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS.

Resource: website

Medicare Physician Fee Schedule

Information on services covered by the Medicare Physician Fee Schedule (MPFS).

Resource: website

Provider Dispute Resolution Process

For more information about the Provider dispute resolution process for contracted and non-contracted Providers, click here

Billing Code Guidelines

Thank you for being a valued partner in providing high quality care to your patients. Periodically, billing codes are updated by regulatory agencies. These guidelines will provide current billing codes and specifications and should be reviewed regularly as billing guidelines may change.