Navigating Medi-Cal

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July 6, 2021

Molly Evans
Program Manager
Healthcare Financial Resources, LLC

Working with Medi-Cal − California Medicaid − can be quite a challenge at times. Navigating their phone system, waiting on hold, utilizing their website and even manually filling out their specialized forms just to get status on a claim can be a daunting task for representatives. You are not alone! There are some challenges when it comes to Medi-Cal, however, knowing some tips and tricks may help ease your mind when you are faced with this payer.

Medi-Cal Manual Forms can be Challenging

Filling out Medi-Cal manual forms can be difficult to adapt to. There are not one, but two different forms that need to be completed at any given time, depending on the scenario and at what time the request is being submitted.

  1. Claims Inquiry Form or CIF: used to request an adjustment for either an underpaid or overpaid claim, request the Share of Cost (SOC) reimbursement or request a reconsideration of a denied claim.
  2. Appeal Form or 90-1: used when all other avenues have been exhausted and an attempt to overturn a denial is being filed.

How do I obtain the CIF and 90-1 forms?

To obtain the CIF and 90-1 forms contact Medi-Cal directly with the provider NPI number and the shipping address of where the forms should be sent. These forms come in boxes of 1,200 each and will also need envelopes to go with them. Once the order is placed, allow 10 days to ship. Make sure you order in plenty of time so as you do not run out!

Completing the Claims Inquiry Form

There are 17 areas on the form that needs to be completed. The form allows entering up to four patients on one form at a time. Information needed will be:

  • Patient name
  • Medi-Cal ID number
  • Claim number
  • Date of service
  • Denied code
  • Amount billed

Box 16 allows the break down what is needed, such as: “Line 1, Line 2, etc.”

Completing the 90-1 Appeal Form

There are 15 areas on the 90-1 form that requires completion prior to submission. This form can only be completed for one patient at a time, but for up to 14-line items that have denied or have different dates of services. Information needed will be:

  • Patient name
  • Medi-Cal ID number
  • Claim number
  • Date of service
  • Remittance Advice Details (RAD) or Explanation of Benefits (EOB)/Remittance Advice (RA) Code
  • Remittance Advice (RA) and Remittance Advice Details (RAD)

Another Complication

Another complication in completing CIF and 90-1 forms is they must be hand-written. This can not only be tiring for the person completing the forms, but the process takes longer and can be difficult to read depending upon the persons handwriting. But is there a better alternative?

HFRI can Help with Completing Medi-Cal Forms

Healthcare Financial Resources (HFRI) has developed a process to eliminate the necessity of hand-writing CIF and 90-1 forms. Utilizing a mail merge process allows each individual staff member to complete an Excel sheet with the requested/required information. This Excel document is transmitted to the dedicated HFRI mailing team who takes the provided data and transfers it onto the form. The benefit to this process is that the forms are legible, cannot be smudged, have a reduced chance for spelling errors and no one’s hand gets cramped!

Your AR specialists

Healthcare Financial Resources (HFRI) specializes in accounts receivable recovery and resolution and serves as a virtual extension of your hospital central billing office to help you quickly resolve and collect more of your insurance accounts receivable.

We utilize proprietary intelligent automation and staff specialization to efficiently process all claims regardless of size or age. In addition to our resolution capabilities, HFRI also can provide denial management assistance by conducting root cause analysis and recommend process improvements to help decrease aged and denied claims going forward.

Contact HFRI today to learn more about how we can help you with your hospital’s accounts receivable management.

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