22378Rev1_Navigating Medi Cal And Specialty Health Programs 22378 22378Rev1 Navigating

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Navigating Medi-Cal and Specialty Health Programs
PROFESSIONAL

INSTITUTIONAL

CMS-1500 claim form

UB-04 claim form

ALLIED HEALTH

MEDICAL SERVICES

Acupuncture
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
and Medical Supplies (DME)
Medical Transportation
Orthotics and Prosthetics
Psychological Services
Therapies

General Medicine (GM)
Obstetrics (OB)

PHARMACY
Pharmacy (PH) Supplies
Pharmacy

*

*

30-1 and 30-4 claim forms

VISION CARE

INPATIENT/OUTPATIENT
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Federally Qualified Health Centers (FQHC)
Heroin Detoxification
Hospice Care Program
Indian Health Services (IHS)
Inpatient Services
Rehabilitation Clinics
Rural Health Clinics (RHC)

Vision Care

HOME & COMMUNITY

SPECIALTY PROGRAMS
PM160 CMS-1500 UB-04 30-1/30-4

MEDI-CAL SPECIALTY PROGRAMS
Comprehensive Perinatal
Services Program (CPSP)**
Every Woman Counts (EWC)**
Presumptive Eligibility (PE)**
OTHER SPECIALTY PROGRAMS
California Children’s Services (CCS)
Child Health and

Disability Prevention (CHDP)
Family Planning, Access, Care
and Treatment (Family PACT)**
Genetically Handicapped
Persons Program (GHPP)
** Health Access Program (HAP)

OUTPATIENT

























UB-04 claim form



AIDS Waiver Program
Community-Based Adult
Services (formerly ADHC)
Expanded Access to Primary Care (EAPC)
Home Health Agencies/Home and
Community-Based Services
Local Educational Agency (LEA)
Multipurpose Senior Services Program
Use this chart to help you navigate the Medi-Cal Learning
Portal (https://learn.medi-cal.ca.gov), understand the
Medi-Cal or specialty provider manual you reference for
policy and billing instructions (for example, the Allied Health
for Therapies manual) and identify the claim form you
use when billing for services rendered.

LTC
25-1 claim form
Long Term Care (LTC)
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