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This document serves as a claim form for counties in California to request reimbursement for administrative costs related to Medi-Cal Specialty Mental Health Services. It includes instructions for
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How to fill out Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement – Administrative Cost

01
Gather necessary documentation, including client information and service details.
02
Complete the claim form accurately, entering the date of service, provider information, and billing codes.
03
Specify the administrative costs being claimed, ensuring alignment with Medi-Cal guidelines.
04
Review the completed claim for accuracy and completeness to avoid rejection.
05
Submit the claim form electronically or via mail to the appropriate Medi-Cal office.
06
Retain a copy of the submitted claim and any supporting documents for your records.

Who needs Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement – Administrative Cost?

01
Service providers who offer mental health services under the Medi-Cal program and incur administrative costs.
02
Organizations providing specialty mental health services that require reimbursement for operational expenses.
03
Healthcare professionals including psychologists, psychiatrists, and therapists involved in Medi-Cal mental health services.
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To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement. The claim form must be filled out in blue or black ink; • The claim form must have an original signature (no copies will be accepted); The Claim Form must include: • A photo copy of your Medi-Cal Beneficiary Identification Card (BIC).
What is MAA? MAA is Medi-Cal Administrative Activities. Local Governmental Agencies (LGAs) that participate in the MAA program are eligible to receive 50% Federal reimbursement for the cost of performing Medi-Cal administrative activities that directly support Medi-Cal services to their clients.
Fee for service (FFS) is the most traditional payment model of healthcare. In this model, the healthcare providers and physicians are reimbursed based on the number of services they provide or their procedures. Payments in an FFS model are not bundled.

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The Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement – Administrative Cost is a financial document submitted by providers to claim reimbursement for administrative costs incurred while providing mental health services under the Medi-Cal program.
Providers of Medi-Cal specialty mental health services are required to file the Quarterly Claim for Reimbursement – Administrative Cost to receive payment for eligible administrative expenses.
To fill out the claim, providers need to complete the required fields accurately, including reporting expenses related to administrative activities. It's essential to follow the guidelines provided by the state, ensuring all necessary documentation is attached.
The purpose of the claim is to facilitate the reimbursement process for mental health service providers, allowing them to recover the administrative costs incurred in delivering care to Medi-Cal beneficiaries.
The claim must report details such as provider information, total administrative expenses incurred, dates of service, and any other relevant data required by the Medi-Cal program to process the reimbursement.
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