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)
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Revised 12/31/2020 | 2020-12-31 |
2 Credentialing Criteria (pdf)
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2020-01-30 | |
3 Credentialing Application Instructions (pdf)
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2020-02-19 | |
4 Provider Clinical Application Medi-Cal (docx)
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Revised 10/22/2021 | 2021-10-29 |
5 FFS Specialty Addition App (docx)
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12/28/2020 | 2020-12-31 |
6 Medi-Cal Documentation Training (pdf)
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12/29/2020 | 2020-12-31 |
7 Form W-9 (pdf)
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2017-11-02 |
LMFT/LCSW/LPCC Billing Codes (pdf)
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09/01/2021 | 2021-09-07 |
MD/DO Billing Codes (pdf)
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09/01/2021 | 2021-09-07 |
PNP/PA Billing Codes (pdf)
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09/01/2021 | 2021-09-07 |
PhD/PsyD Billing Codes (pdf)
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09/01/2021 | 2021-09-07 |
CPT Codes 90846 and 99201 REMOVED from Fee Schedule (pdf)
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Effective 04/01/2021 | 2022-01-27 |
CalAIM Changes to Medical Necessity, Diagnosis & Reasons for Recoupment (pdf)
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Effective 01/01/2022 | 2022-01-27 |
False Claims Act Requirement 2022 (pdf)
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Effective 01/13/2022 | 2022-01-27 |
HSD Pharmacy Benefit Quick Guide (pdf)
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Effective 01/01/2022 | 2022-01-27 |
Mandatory E-Prescriptions (pdf)
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Effective 01/01/2022 | 2022-01-27 |
Microsoft Word - Optum Response to Presumptive Transfer Inquiries in SD -3.9.18
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OPTUMIST Newsletter Fall 2021 (pdf)
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10/29/2021 | 2021-11-02 |
OPTUMIST Newsletter Spring 2021 (pdf)
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2021-05-03 | |
OPTUMIST Newsletter Summer 2021 (pdf)
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07/31/2021 | 2021-09-08 |
OPTUMIST Newsletter Winter 2021 (pdf)
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2021-01-29 | |
Request to Complete Short Questionnaire (pdf)
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Sent - 10/19/2021 | 2021-10-19 |
Therapeutic Behavioral Services Prior Authorization Request & Referral Process (pdf)
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Memo - August 9, 2019 | 2019-08-09 |
FFS Operations Handbook (pdf)
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Revised 01/31/2021 | 2021-01-13 |
Inpatient Operations Manual (pdf)
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Revised 07/30/2020 | 2021-10-26 |
Adult MediCal Mental Health Severity Analysis Tool (pdf)
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2016-08-30 | |
Demographic Form Fill - Required Fields (pdf)
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Revised 06/01/2021 | 2021-10-14 |
MediCal Behavioral Health Quick Guide (pdf)
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2016-08-10 | |
MediCal Quick Reference Guides (pdf)
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2015-10-09 | |
Mild-Moderate-Severe FAQs (pdf)
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Effective 09/01/2016 | 2016-10-24 |
Timely Access to Care (pdf)
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2018-04-30 |
Beneficiary Form Tables.xlsx
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2020-04-14 | |
DHCS Reasons for Recoupment FY 19-20 (pdf)
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2020-05-22 | |
DHCS Reasons for Recoupment FY 20-21 (pdf)
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2021-03-19 | |
Documentation Tip Sheet (pdf)
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Revised 04/13/2020 | 2020-04-13 |
Initial Client Checklist (pdf)
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Revised 04/2020 | 2020-04-09 |
Pre-Credentialing_Site_Review_Tool_(pdf)
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2019-10-30 | |
Reasons for Recoupment Quick Guide FY 18-19 (pdf)
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2019-02-01 | |
Record Keeping and Treatment Record Requirements (pdf)
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2017-08-07 | |
Site Review Tool (pdf)
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2020-09-17 | |
Treatment Record Review Tool (pdf)
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Revised 07/07/2021 | 2021-07-07 |
Inpatient Professional Service Documentation Guide (pdf)
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2018-07-12 | |
Inpatient Review Tool (pdf)
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2017-08-07 |
Optum San Diego Website Provider Registration Instructions (pdf)
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Updated 08/19/2019 | 2019-08-19 |
Federal and State False Claims Act - Contractor Roles and Responsibilities (pdf)
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PowerPoint Presentation | 2020-04-03 |
New Provider Orientation
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PowerPoint Presentation | 2018-11-16 |
Privacy and Security Training (pdf)
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Presentation | 2019-08-14 |
Provider Orientation Presentation (pdf)
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Revised 10/21/2021 | 2021-10-21 |
Quick Guide to Provider Orientation (pdf)
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2019-02-13 |
CANS Instructions and Process (pdf)
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Updated 08/01/2019 | 2019-08-05 |
CANS User Guide (pdf)
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v1.0 July 2019 | 2019-09-16 |
CANS-PSC Completion Tip Sheet with link to Tools (pdf)
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Updated 08/01/2019 | 2019-08-05 |
CYF mHOMS Client Information Sheet (pdf)
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Revised 07/01/2020 | 2020-08-06 |
Electronic CANS & PSC Resources (pdf)
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04/02/2020 | 2020-04-02 |
Electronic CANS Form (pdf)
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04/02/2020 | 2020-04-02 |
Electronic CANS Form – Early Childhood Version (pdf)
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2020-04-22 | |
Electronic PSC - Parent Form (pdf)
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04/02/2020 | 2020-04-02 |
Electronic PSC - Parent Form - Spanish (pdf)
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04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form (pdf)
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04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form - Spanish (pdf)
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04/02/2020 | 2020-04-02 |
Change From a Group to a Private Practice (pdf)
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05/01/2020 | 2020-05-05 |
Change of Address, Phone, Demographics Form (pdf)
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05/01/2020 | 2020-05-05 |