Integrative Consulting Solutions
"The important thing is to never stop questioning." - Albert Einstein
Frequently Asked Questions
How to get s​et up with Medi-Cal
How do I set up an National Provider Identification Number (NPI)?
- Before being able to do anything else, you will need an NPI number. If you have never applied for one, please shoot us an email and we will be happy to assist you!
Do I need an NPI number to become a Medi-Cal Provider?
- Yes, you will need your NPI number in order to apply to become a Medi-Cal Provider.
How to become a Medi-Cal provider?
- Once you have your NPI number, you are able to become a Medi-Cal Provider. There multiple forms that are required by Medi-Cal and about a 6 month waiting period before you will receive your approval. This can be the most frustrating part of the process for any new INP. As we have gone through the process before, we are well skilled at helping you navigate through it!
How to set up access to my Medi-Cal "back office"?
- Once you have been approved by Med-Cal, there is a simple form to fill out in order to access what we like to call your "Medi-Cal Back Office". It is the place where you can submit your plan of treatment's for approval and check the status of claims.
How do I set up direct deposit?
- Direct Deposit is a single page form to be filled out and sent it to Medi-Cal. Once received, it can take up to 6 months for you checks to arrive in bank account, so expect paper checks for a few months.
How do I set up access for Electronic Billing?
- Again, more forms to fill out, but luckily, this one only takes about 30 days to process! We have all the forms, so let us know if you need any help!
Preparing for Submissions and Approvals
What is a Plan of Treatment (POT)?
- A POT is a 12 page document that is required when requesting approval for PDN hours. It covers everything your little one requires on a daily basis in your care, from feeding requirements, medications, therapies, treatment outlines and progress notes. It is signed by both you and the main PCP or specialist your little one sees. Part of our all-inclusive service that we offer at ICS is the completion of the initial POT using the documents we've requested from you, and updates there after. It's one of the most time consuming parts of the process, and we gladly take that off your plate!
What needs to accompany my POT when I submit for approval of PDN hours?
- No matter where you are submitting your request to, there are basic things required. Your POT, an assessment, 5 days of nursing notes, a MAR, at times a feeding log, and your RN/LVN license, your driver's license, your current CPR card, and liability insurance.
What type of insurance do I need?
- You will need to show liability insurance.
What licenses am I required to have?
- RN/LVN license, driver's license in good standing
How do I know where to send my POT for approval?
- Some children have straight Medi-Cal, some have a combination of Medi-Cal, CCS and/or managed care plans, and some children live in whole child county systems. Where you send your POT just depends on what combination your little one has.
Medi-Cal, CCS, Managed Care Plans, and Whole Child Model
What is Medi-Cal?
"Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes." Every placement you receive will have Medi-Cal.
What is CCS?
- ​California Children's Services (CCS) is a state program for children with certain diseases or health problems. Through this program, children up to 21 years old can get the health care and services they need. Not all children that are covered under Medi-Cal will have CCS. If you are unsure if your child has CCS, a simple call to their social worker should be able to answer the question. If you are unsure if their conditions requiring PDN services is covered under CCS, we can help with that!
What is a Managed Care Plan (MCP)?
- Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. Many times, children are assigned a MCP without your knowledge, consent, or desire. They do not cover LVN PDN hours, only RN PDN hours. If your child has a MCP, we would highly recommend removing it. Your social worker can take care of that for you.
What is a Whole Child Model County?
- In 2019, many counties in northern California, as well as some in central and southern California, switched to a Whole Child Model. Though the intention with the Whole Child Model was to make the care for your little one easier, it most definitely has not. And unlike a MCP, you cannot opt out of it. If you live in one of the WCM counties listed below, please contact us at ICS for help navigating this extra layer of bureaucracy: San Luis Obispo, Santa Barbara, Orange County, Merced, Monterey, Santa Cruz, San Mateo, Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity, and Yolo.
Billing, Claims, Appeals, Voids, and Denials
How to submit an electronic claim?
- Electronic claims can be filled in and submitted in a separate "back office" that is accessible by, you guessed it, another form to fill out and send in for processing.
When to submit paper claims?
- If you do not have electronic access yet, you can submit paper claims. You also will need to submit paper claims if the dates on the claim are over a year old.
Checking the status of a claim?
- You are able to check the status of submitted claims by logging into you Medi-Cal back office.
When do claims approve?
- Claims approve every Monday, and checks or direct deposits will be received within 5-10 business days.
Finding and understanding your Remittance Advice Detail (RAD)?
- You RAD is like an insurance EOB and can be access in your Medi-Cal back office. It contains all important information regarding your claim, so make sure to hold on to them in case any issues arise.
What are RAD codes?
- RAD codes are codes that explain the reason you were paid what you were paid, or the reason why you weren't paid what you may have been expecting. The code will always have a definition with it, so you don't have to go searching for what the code means.
What to do if your claim denies?
- If you have a claim that denies, first check to make sure all the information you entered is accurate. Most of the time it's human error. If you do find you made a mistake, resubmit the claim with the corrected information. If you feel the error is on the part of Medi-Cal, you will need to appeal the claim.
How to appeal a claim?
- You guessed it, another form! You can submit in writing why you feel the claim denied incorrectly, with any sort of documentation to support your case. But you only have one chance to appeal a claim, so make sure you case is as air tight as possible.
How to void a claim?
- If you need to void a claim, ha, another form. Many times, you void claims in order to correct a mistake that has affected your payment. It will create a negative balance with Medi-Cal, but allow you to resubmit for the correct amount.
What to do if you check is lost or stolen?
- Unfortunately, those ONLY was to have a lost or stolen check re-issued is by physically writing "Cash Control' (the state controller's office) with an explanation as to why you are requesting a check be re-issued. They send you forms back, you fill them out and return them, they send you more forms, and if you're lucky you'll have a new check anywhere from 2-12 months later.