Assignment of Insurance Benefits Form (pdf)
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Revised 05-20-19 |
2019-07-22 |
Claim Item Hold Reasons-revised 09.20233 (pdf)
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The Hold Reasons list should be used when putting claims in hold status. |
2023-09-20 |
DHCS 100186 Instructions (pdf)
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How to complete the form |
2020-09-25 |
DHCS 100186 or Claim Submission Certification Form (pdf)
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Required billing certification form when submitting claim batch |
2020-09-25 |
DHCS 6065A Form (pdf)
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Late billing Good Cause Certification |
2021-01-06 |
DHCS 6065A Form (xlsx)
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Late billing Good Cause Certification |
2021-01-06 |
DHCS 6065B Form (pdf)
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Late billing and Good Cause Certification for DRC 8 |
2021-01-06 |
DMC-ODS Billing Manual v-1.5 (pdf)
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The DMC-ODS Billing Manual is a DHCS publication which outlines the processes and rules for SD/MC claims for DMC-ODS services. |
2024-04-11 |
DMC-ODS Service Table- v. 1.5 (xlsx)
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The DMC-ODS Service Table consists of service code, modifiers, lockouts, allowable place of service, and more. |
2024-04-15 |
DSM5-ICD10 Diagnosis Quick Guide (pdf)
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DSM5 and ICD-10 guide |
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Instructions on Completing 6065A Form
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2021-01-06 |
Instructions on Completing 6065B Form
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2021-01-06 |
OTP Billing SanWITS Screens 11-21-2018 (pdf)
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2018-12-06 |
OTP Disallowance After Release to Billing (pdf)
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How to handle disallowances following the release to billing. Revised 12-15-2021 |
2021-12-16 |
OTP Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
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The document provides guidelines for OTP providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. |
2023-12-13 |
OTP OOC Medi-Cal Tip Sheet (pdf)
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2023-03-28 |
OTP: Encounter Entry for Medi-Medi Methadone Claims v. 03.2024 (pdf)
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The purpose of this tip sheet is to provide guidance to OTP programs on entering Medi-Medi Methadone claims in 7-day increments in SanWITS if Medi-Cal needs to be billed for unpaid costs by the primary insurance. This tip sheet is subject to change |
2024-04-01 |
Outpatient Disallowance After Release to Billing (pdf)
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This document is a revised version of the Disallowance After Release to Billing. It contains instructions on how to handle disallowances following the release to billing. |
2021-12-16 |
Outpatient OHC or Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
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The document provides guidelines for Outpatient providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. |
2023-12-13 |
Outpatient OOC Medi-Cal Tip Sheet (pdf)
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2023-03-28 |
Outpatient Provider Billing SanWITS Screens (pdf)
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Revised 06-14-2019 |
2019-06-21 |
PGE or Benefit Plan Review Billing Tip Sheet 11-19-2018 (pdf)
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2018-12-06 |
Payment Recovery Form_revised 08.2023 (xlsx)
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The Payment Recovery Form is used by DMC Provider to report adjustable units of service. Tab 2- Instructions. Tab 3- Summary of Changes. |
2023-08-24 |
Residential Bed Day Billing SanWITS Screens (pdf)
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Rev 05-01-2019 |
2019-06-10 |
Residential Bed Day Disallowance After Release to Billing (pdf)
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How to handle disallowances following the release to billing. Revised 01/26/2022 |
2022-01-26 |
Residential Care Coordination OHC or Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
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The document provides guidelines for Residential providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. |
2023-12-13 |
Residential Case Management Disallowance After Release to Billing (pdf)
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How to handle disallowances following the release to billing. Revised 02-07-2022 |
2022-02-07 |
Residential Case Management-Recovery Services SanWITS Screens (pdf)
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Rev 05-22-2019 |
2019-06-10 |
Residential OOC Medi-Cal Tip Sheet (pdf)
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2023-03-28 |
SUD Aid Code Master Chart (xlsx)
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2023-05-05 |
SUD Billing Announcement: Medicare Advantage Plan Rules for OTP Providers (msg)
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Email announcement regarding Medicare Advantage billing rules |
2022-07-14 |
SUD Billing Announcement: Other Health Coverage Rules for Outpatient Providers (msg)
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Email announcement regarding OHC Rules |
2022-07-14 |
SUD Billing Announcement: Other Health Coverage Rules for Residential Providers (msg)
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Email announcement regarding OHC Rules |
2022-07-14 |
SUD Claim Errors and Guides
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The purpose of this tip sheet is to give advice on how to avoid and fix both common and new billing errors. |
2023-10-04 |