Disputing Medi-cal and CCS Denials

-If there is no correspondance on a medi-cal claim, be sure to visit the Medi-cal site at: https://www.medi-cal.ca.gov/MCWebPub/Login.aspx and select "claim Status inquiry" under the "CLAIMS" category.

-Fill out the appropriate information considering there is no payer claim control number.

-If no information populates, chances are Medi-cal never received and processed the claim so we need to re-bill it with the report attached. If the claim was denied, details will populate with the denial reason, therefore you will need to dispute the claim with the options below.

When to use a CIF form:

The Claims Inquiry Form (CIF) is used to request an adjustment for either an underpaid or overpaid claim, request a Share of Cost (SOC) reimbursement or request reconsideration of a denied claim. The CIF can also be used as a tracer. Use the Remittance Advice Details(RAD) as described below to reconcile claims pending follow-up:

Review the link below for additional details.

https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/cifco.pdf

When to use a the Appeal Form:

This section describes the instructions for completing an Appeal Form (90-1). An appeal is the final step in the administrative process and a method for Medi-Cal providers with a dispute to resolve problems related to their claims.

Review the link below for additional details.

https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/appealform.pdf