California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 1 - Department of Mental Health
Chapter 11 - Medi-Cal Specialty Mental Health Services
Subchapter 5 - Problem Resolution Processes
Article 3 - Provider Problem Resolution and Appeal Processes
Section 1850.325 - Provider Appeal Process - Claims Processing
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
Notwithstanding Sections 1850.305-1850.320:
(a) A Fee-for-Service/Medi-Cal hospital or a psychiatric nursing facility may file an appeal concerning the processing or payment of its claims for payment for services directly to the fiscal intermediary postmarked or FAXED within 90 calendar days of the date the payment was due. The fiscal intermediary shall have 60 calendar days from the receipt of the appeal to make a determination in writing to the provider.
(b) An MHP may file an appeal concerning the processing or payment of its claim for services paid through the Short-Doyle/Medi-Cal system to the Department postmarked or FAXED within 90 calendar days of the date the payment was due. The Department shall have 60 calendar days from the receipt of the appeal to make a determination in writing to the MHP.
1. New section
filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. Change
without regulatory effect amending NOTE filed 7-29-2014 pursuant to section
100, title 1, California Code of
Regulations (Register 2014, No. 31).
Note: Authority cited: Sections 14680, 14700 and 14718, Welfare and Institutions Code. Reference: Sections 14684 and 14718, Welfare and Institutions Code.
