Medicaid of California Claims Address for Providers

The primary mailing address for California Medicaid fee-for-service professional claims is California MMIS Fiscal Intermediary, P.O. Box 15700, Sacramento, CA 95852-1700.1California MMIS. CMS-1500 Submission and Timeliness Instructions Institutional, dental, and pharmacy claims each go to their own address. Before you use any of them, confirm your patient is enrolled in fee-for-service Medi-Cal and not a managed care plan, because most beneficiaries are in managed care and their claims go somewhere else entirely.

Check the Delivery System Before You Mail Anything

About 94 percent of Medi-Cal beneficiaries are enrolled in managed care plans, leaving roughly 6 percent in traditional fee-for-service.2DHCS.ca.gov. Medi-Cal Monthly Enrollment Fast Facts Managed care claims go directly to the patient’s health plan, not to the Fiscal Intermediary. Sending a managed care claim to the P.O. Boxes below will result in denial after weeks of processing.

Verify a patient’s delivery system by checking their Benefits Identification Card or by running an eligibility inquiry through the Medi-Cal Provider Portal. The addresses in this article apply only once you’ve confirmed the patient is fee-for-service.

Paper Claim Addresses by Claim Type

The Department of Health Care Services contracts with a Fiscal Intermediary to run the California Medicaid Management Information System (CA-MMIS), which receives and processes fee-for-service claims. The correct P.O. Box depends on the form and the type of service.

Medical Claims

These addresses are for completed claim forms only. General correspondence, appeals, and enrollment paperwork go elsewhere.

Dental Claims

Medi-Cal Dental (formerly Denti-Cal) paper claims are mailed to Medi-Cal Dental, P.O. Box 15540, Sacramento, CA 95852-1540.4Medi-Cal. Medi-Cal Dental Program for Inpatient and Outpatient Services

Pharmacy Claims

Pharmacy services are handled through Medi-Cal Rx, which is administered separately from the CA-MMIS Fiscal Intermediary. Paper pharmacy claims go to the Medi-Cal Rx Customer Service Center, P.O. Box 610, Rancho Cordova, CA 95741-0610.5CA.gov. Medi-Cal Rx Resources and Contact Information

Formal Appeals

A formal first-level appeal on Form 90-1 goes to a different address from claim submissions: Attn: Appeals Unit, California MMIS Fiscal Intermediary, P.O. Box 15300, Sacramento, CA 95851-1300. The appeal must be received within 90 calendar days of the Notice of Action denying the claim and must include the patient’s name and Medi-Cal ID, your provider name and number, the date of service or notice, a copy of the Notice of Action, a written explanation, and any supporting documentation.6Medi-Cal. Appeal Form Completion If the denial looks like a processing error or you have additional documentation, a Claims Inquiry Form (CIF) submitted within six months of the denial date on the Remittance Advice Details is often the faster path.7Medi-Cal. CIF Overview

What Has to Be on the Claim

Both CMS-1500 and UB-04 forms require certain information, and missing fields cause denials or delays. Include your National Provider Identifier and your assigned Medi-Cal Provider Identification Number, the beneficiary’s Client Identification Number (CIN) from their Benefits Identification Card, ICD-10 diagnosis codes, HCPCS or CPT procedure codes for every billed service, and the authorized signatures for medical release and assignment of benefits.

Paper claim forms must be originals purchased from an approved source. The CMS-1500 and UB-04 are pre-printed in specific ink colors so OCR scanners can distinguish the form template from your entries. Photocopies, carbon copies, and computer-generated reproductions are not accepted.8Medi-Cal. Legibility and Completion Standards Do not fill in the form with red ink or red pencil; the scanner is designed to ignore the red-printed template and will ignore your entries too.

Filing Deadlines and the Late-Filing Penalty

Medi-Cal’s timely-filing rules directly reduce payment when you miss the window. Under California Welfare and Institutions Code Section 14104.3:9California Legislative Information. California Code WIC 14104.3

  • Received within six months after the month of service: full reimbursement.
  • Received in months 7 through 9: 75 percent of the otherwise payable amount.
  • Received in months 10 through 12: 50 percent.
  • After 12 months: generally not payable.

The clock starts on the last day of the month you provided the service, not the date of service. For services provided on March 3, the six-month window runs from April 1 through September 30.

The Faster Alternative: Electronic Submission

Paper claims are slow and error-prone. The preferred method for Medi-Cal fee-for-service claims is electronic submission using the ASC X12N 837 transaction format, either through the Medi-Cal Provider Portal or an approved clearinghouse.10California MMIS. Electronic Methods for Eligibility Transactions and Claim Submissions You get immediate confirmation that the Fiscal Intermediary received the claim, and processing is significantly faster. Remittance Advice Details are available for download through the Provider Portal’s Correspondence Center once each claim is processed.11Medi-Cal. Remittance Advice Details – Electronic

Where to Call With Questions

For claim status, eligibility verification, or submission issues, the Medi-Cal Telephone Service Center is available at 1-800-541-5555, Monday through Friday, 8 a.m. to 5 p.m.12California MMIS. Contact Us Pharmacy providers should contact the Medi-Cal Rx Customer Service Center or use the Medi-Cal Rx provider portal.