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COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH PROGRAM SUPPORT BUREAU MEDICAL PROFESSIONAL SERVICES AND AUTHORIZATIONS DIVISION Date: TO: Marlene Shahverdian CIO Help Desk 695 S. Vermont Avenue,
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How to fill out medi-cal professional services and

01
To fill out medi-cal professional services, follow these steps:
02
Obtain the necessary forms: You can download the forms from the official Medi-Cal website or request them from your local Medi-Cal office.
03
Fill out the provider information: Provide your name, address, contact details, and any other required information accurately.
04
Provide patient information: Fill in the patient's name, date of birth, social security number, and any other requested details.
05
Specify the services provided: Clearly outline the professional services rendered, including date, duration, diagnosis, treatment, and any relevant codes.
06
Include supporting documentation: Attach any necessary documentation, such as medical records, test results, invoices, or referrals.
07
Review and double-check: Ensure all the information provided is accurate and complete before submitting the form.
08
Submit the form: Send the completed form along with any accompanying documents to the designated Medi-Cal office via mail or online submission portal.
09
Follow up: Keep track of the submission and follow up with the Medi-Cal office if needed to ensure timely processing.

Who needs medi-cal professional services and?

01
Medi-Cal professional services are primarily required by:
02
- Healthcare providers who render medical services to Medi-Cal beneficiaries.
03
- Healthcare facilities, such as hospitals, clinics, nursing homes, and rehabilitation centers that treat Medi-Cal eligible patients.
04
- Individuals who qualify for Medi-Cal coverage and seek professional medical services, including doctors, specialists, therapists, and other healthcare professionals.
05
It is essential for those eligible for Medi-Cal and healthcare providers accepting Medi-Cal to understand and utilize the professional services aspect of Medi-Cal to ensure proper reimbursement and access to necessary healthcare.
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Medi-Cal professional services refers to the billing and reimbursement process for medical services provided by healthcare professionals to Medi-Cal beneficiaries.
Healthcare professionals who provide medical services to Medi-Cal beneficiaries are required to file Medi-Cal professional services.
To fill out Medi-Cal professional services, healthcare professionals need to document the services provided, the corresponding diagnosis and procedure codes, and submit the claims to the Medi-Cal program.
The purpose of Medi-Cal professional services is to ensure that healthcare professionals are reimbursed for the medical services they provide to Medi-Cal beneficiaries.
Information such as the services provided, diagnosis codes, procedure codes, provider information, and patient demographics must be reported on Medi-Cal professional services.
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