Fee for Service Providers
TERM Specialty Network Applications
This page is utilized by Fee For Service MediCal Providers to obtain documentation related to participation on the MediCal panel and continued authorizations for treatment.
1 Instructions and FAQs Credentialing and Contracting (pdf)
|
Revised 02/12/2020 | 2020-02-19 |
2 Credentialing Criteria (pdf)
|
2020-01-30 | |
3 Credentialing Application Instructions (pdf)
|
2020-02-19 | |
4 Provider Clinical Application Medi-Cal (docx)
|
Revised 02/20/2020 | 2020-02-20 |
5 FFS Clincal Speciality Addition App (docx)
|
2018-07-10 | |
6 RIHS Account Instructions (pdf)
|
2019-06-17 | |
7 Form W-9 (pdf)
|
2017-11-02 |
LMFT/LCSW/LPCC Codes (pdf)
|
2019-11-07 | |
MD DO Psychiatrist Codes (pdf)
|
2019-11-07 | |
PNP Codes (pdf)
|
2019-11-07 | |
PhD PsyD Psychologist Codes (pdf)
|
2019-11-07 |
FFS Provider Operations Handbook (pdf)
|
Revised 01/31/2020 | 2020-01-30 |
Inpatient Operations Manual (pdf)
|
Revised 01/15/2020 | 2020-02-03 |
Site_Review_Tool.pdf
|
||
DHCS Reasons for Recoupment FY 18-19 (pdf)
|
For DOS 7/1/18-6/30/19 | 2019-03-22 |
Beneficiary Materials MHP Order Form (pdf)
|
2020-04-14 | |
DHCS Reasons for Recoupment FY 17-18 (pdf)
|
For DOS 7/1/17-6/30/18 | 2017-11-06 |
Documentation Tip Sheet (pdf)
|
Revised 04/13/2020 | 2020-04-13 |
Initial Client Checklist (pdf)
|
Revised 04/2020 | 2020-04-09 |
Pre-Credentialing_Site_Review_Tool_(pdf)
|
2019-10-30 | |
Reasons for Recoupment Quick Guide FY 18-19 (pdf)
|
2019-02-01 | |
Record Keeping and Treatment Record Requirements (pdf)
|
2017-08-07 | |
Treatment Record Review Tool (pdf)
|
2019-07-08 |
Inpatient Professional Service Documentation Guide (pdf)
|
2018-07-12 | |
Inpatient Review Tool (pdf)
|
2017-08-07 |
Optum San Diego Website Provider Registration Instructions (pdf)
|
Updated 08/19/2019 | 2019-08-19 |
Federal and State False Claims Act - Contractor Roles and Responsibilities (pdf)
|
PowerPoint Presentation | 2020-04-03 |
Fee for Service Outpatient Changes For Psychiatric Services (pptx)
|
PowerPoint Presentation | 2018-11-16 |
Privacy and Security Training (pdf)
|
Presentation | 2019-08-14 |
Provider Orientation Presentation (pdf)
|
2018-11-16 | |
Quick Guide to Provider Orientation (pdf)
|
2019-02-13 |
CANS Instructions and Process (pdf)
|
Updated 08/01/2019 | 2019-08-05 |
CANS User Guide (pdf)
|
v1.0 July 2019 | 2019-09-16 |
CANS-PSC Completion Tip Sheet with link to Tools (pdf)
|
Updated 08/01/2019 | 2019-08-05 |
CYF mHOMS Client Information Sheet (pdf)
|
2019-08-02 | |
Electronic CANS & PSC Resources (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic CANS Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Parent Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Parent Form - Spanish (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form - Spanish (pdf)
|
04/02/2020 | 2020-04-02 |