This page is utilized by Fee For Service MediCal Providers to obtain documentation related to participation on the MediCal panel and continued authorizations for treatment.
Applications
1 Instructions and FAQs Credentialing and Contracting (pdf)
|
Revised 12/31/2020 | 2020-12-31 |
2 Credentialing Criteria (pdf)
|
2020-01-30 | |
3 Credentialing Application Instructions (pdf)
|
2020-02-19 | |
4 Provider Clinical Application Medi-Cal (docx)
|
12/28/2020 | 2020-12-31 |
5 FFS Specialty Addition App (docx)
|
12/28/2020 | 2020-12-31 |
6 Medi-Cal Documentation Training (pdf)
|
12/29/2020 | 2020-12-31 |
7 Form W-9 (pdf)
|
2017-11-02 |
Beneficiary Materials
Claims
LMFT/LCSW/LPCC Billing Codes (pdf)
|
Revised 07/01/2020 | 2020-07-06 |
MD/DO Billing Codes (pdf)
|
Revised 07/01/2020 | 2020-07-06 |
PNP Billing Codes (pdf)
|
Revised 07/01/2020 | 2020-07-06 |
PhD/PsyD Billing Codes (pdf)
|
Revised 07/01/2020 | 2020-07-06 |
Communications/Updates
OPTUMIST Newsletter Fall 2020
|
2020-11-04 | |
OPTUMIST Newsletter Spring 2020 (pdf)
|
2020-04-30 | |
OPTUMIST Newsletter Summer 2019 (pdf)
|
2019-08-12 | |
OPTUMIST Newsletter Winter 2021 (pdf)
|
2021-01-29 | |
Optum Response to Presumptive Transfer Inquiries in SD
|
2018-03-14 | |
Therapeutic Behavioral Services Prior Authorization Request & Referral Process (pdf)
|
Memo - August 9, 2019 | 2019-08-09 |
Forms
Manuals
FFS Operations Handbook (pdf)
|
Revised 01/31/2021 | 2021-01-13 |
Inpatient Operations Manual (pdf)
|
Revised 01/15/2020 | 2020-02-03 |
Quick Reference
Adult MediCal Mental Health Severity Analysis Tool
|
2016-08-30 | |
Children, Youth and Families (CYF) Behavioral Health Services Provider Resource Manual
|
2017-03-09 | |
Demographic Form Fill - Required Fields
|
2018-12-06 | |
Example - Outpatient Authorization Request - Therapists
|
2018-12-11 | |
MediCal Behavioral Health Quick Guide
|
2016-08-10 | |
MediCal Quick Reference Guides
|
2015-10-09 | |
Mild-Moderate-Severe FAQs
|
2016-10-24 | |
Outpatient Authorization Request Form - Therapists
|
2018-12-03 | |
Outpatient Authorization Request Form - Therapists
|
2018-12-03 | |
Outpatient Authorization Request Form Psychiatry – Required Fields
|
2019-02-08 | |
Outpatient Authorization Request Form Therapists - Required Fields
|
2018-12-13 | |
Outpatient Authorization Request Psychiatry Tip Sheet (doc)
|
Revised 09/10/2020 | 2020-09-14 |
Timely Access to Care
|
2018-04-30 |
Review - Outpatient
Site_Review_Tool.pdf
|
||
DHCS Reasons for Recoupment FY 18-19 (pdf)
|
For DOS 7/1/18-6/30/19 | 2019-03-22 |
Beneficiary Materials MHP Order Form (pdf)
|
2020-04-14 | |
DHCS Reasons for Recoupment FY 17-18 (pdf)
|
For DOS 7/1/17-6/30/18 | 2017-11-06 |
DHCS Reasons for Recoupment FY 19-20 (pdf)
|
2020-05-22 | |
DHCS Reasons for Recoupment FY 20-21 (pdf)
|
2021-03-19 | |
Documentation Tip Sheet (pdf)
|
Revised 04/13/2020 | 2020-04-13 |
Initial Client Checklist (pdf)
|
Revised 04/2020 | 2020-04-09 |
Pre-Credentialing_Site_Review_Tool_(pdf)
|
2019-10-30 | |
Reasons for Recoupment Quick Guide FY 18-19 (pdf)
|
2019-02-01 | |
Record Keeping and Treatment Record Requirements (pdf)
|
2017-08-07 | |
Treatment Record Review Tool (pdf)
|
2019-07-08 |
Review - Inpatient
Inpatient Professional Service Documentation Guide (pdf)
|
2018-07-12 | |
Inpatient Review Tool (pdf)
|
2017-08-07 |
Review - Medication Quality Assurance
Optum Adult Medication QA Tool (pdf)
|
2021-03-26 | |
Optum Child Adolescent Medication QA Tool (pdf)
|
2021-03-26 |
QI Corner
Training
Optum San Diego Website Provider Registration Instructions (pdf)
|
Updated 08/19/2019 | 2019-08-19 |
Federal and State False Claims Act - Contractor Roles and Responsibilities (pdf)
|
PowerPoint Presentation | 2020-04-03 |
Fee for Service Outpatient Changes For Psychiatric Services (pptx)
|
PowerPoint Presentation | 2018-11-16 |
Privacy and Security Training (pdf)
|
Presentation | 2019-08-14 |
Provider Orientation Presentation (pdf)
|
2018-11-16 | |
Quick Guide to Provider Orientation (pdf)
|
2019-02-13 |
CANS/PSC
CANS Instructions and Process (pdf)
|
Updated 08/01/2019 | 2019-08-05 |
CANS User Guide (pdf)
|
v1.0 July 2019 | 2019-09-16 |
CANS-PSC Completion Tip Sheet with link to Tools (pdf)
|
Updated 08/01/2019 | 2019-08-05 |
CYF mHOMS Client Information Sheet (pdf)
|
Revised 07/01/2020 | 2020-08-06 |
Electronic CANS & PSC Resources (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic CANS Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic CANS Form – Early Childhood Version (pdf)
|
2020-04-22 | |
Electronic PSC - Parent Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Parent Form - Spanish (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form (pdf)
|
04/02/2020 | 2020-04-02 |
Electronic PSC - Youth Form - Spanish (pdf)
|
04/02/2020 | 2020-04-02 |
COVID-19
Provider Services Info
Change of Practice Forms
Change From a Group to a Private Practice (pdf)
|
05/01/2020 | 2020-05-05 |
Change of Address, Phone, Demographics Form (pdf)
|
05/01/2020 | 2020-05-05 |
Telehealth Attestation/Standards
Standards of Practice for Telehealth
|
12/28/2020 | 2020-12-29 |
Telemental Health Attestation
|
12/28/2020 | 2020-12-29 |