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Provider resources

Provider authorization appeal and claims dispute

If you are a provider and would like to file an authorization and/or claims dispute, please download the appropriate form below and submit it to KHS for review and a final decision.

Prior authorization list

The Footer in the above PDF contains the date and time the list was generated.

Medi-Cal rates and codes

The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system. http://files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp

Alpha-numeric HCPCS files. These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.

Additional information can be found at http://www.medi-cal.ca.gov.

KHS Adjustment Codes. These provide descriptive adjustment codes that help anyone looking for status determine how a claim was processed.

 

Department of Managed Health Care

The Department of Managed Health Care (DMHC) is committed to protecting health care consumers. The DMHC makes sure that health plans follow the law and remain financially stable. They work every day to solve health care problems and make sure all Californians get the right care at the right time.

To learn more about the DMHC, please visit their website

Child and Adolescent Obesity Provider Toolkit

Fluoride varnish resources