Medical Bill Review Forms for Santa Clara
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FAQ
Providers who need a Provider Forms Reorder Request for either hard copy or electronic billing should contact the Telephone Service Center (TSC) at 1-800-541-5555.
Providers without access to the Medi-Cal website can call the Automated Eligibility Verification System (AEVS) at 1-800-456-2387 and receive a confirmation number and enter this number in the Remarks area/Reserved For Local Use field (Box 19) of the claim.
When eligibility is reduced from full to restricted scope Medi-Cal for a case that is in a managed care health plan, a 59 hold will be put on the Medi-Cal Eligibility Data System (MEDS) record. This hold will prevent re-enrollment into managed care.
Overview: The Provider's Request for Second Bill Review (DWC Form SBR-1) is used to initiate the second bill review process required by Labor Code sections 4603.2(e), for medical treatment services and goods, and by Labor Code section 4622, for medical-legal services, to dispute the amount of payment.
(800) 541-5555 (outside of California, please call 916-636-1980) or online at "Contact Medi-Cal". For the most current information about billing and claims submission, refer to the "Medi-Cal Newsroom" area on the Medi-Cal home page. 4.
It is usually a request from a beneficiary for an LOA/MC 180 to pay for bills more than one year after the date of service that starts the process to determine if an administrative error occurred.