| Using the
CenCal Health Website
How do I obtain a website account?
http://www.cencalhealth.org/for_providers/providers_only/index.html
How do I obtain a website guide?
http://www.cencalhealth.org/for_providers/manuals.html
What is the difference between my username and my provider #?
o A Provider Number is used for billing
o A Username is used to access the CenCal Health website
I forgot my password and am locked out. What do I do?
o Call your administrator as the password may have been changed at office level
o Contact the webmaster at
webmaster@cencalhealth.org with the following information:
--> Provider Name, Your name, Phone, Username
How do I add the website to My Favorites? How do I remove it?
o On most browsers select "Favorites" and "Add to Favorites"
o On most browsers select "Favorites" and "Organize Favorites" select the item and click "delete"
Note: Only add the main site (www.cencalhealth.org) to your favorites.
CenCal Health is constantly improving the website and if a change is required your favorites may not be able to find the site.
Why does the website populate information in different forms? (Internet settings)
o Browsers remember sites visited by the user in the form of "cookies"
o Cookies should be periodically cleaned out as your browser gets "confused" occasionally.
1. Go to "Tools" -> "Internet Options" on the browser menu
2. On the "General Tab" click "Delete Cookies" and delete all of the cookies.
Why are website transactions more efficient than Paper? Features on
www.cencalhealth.org website include: instant transactions, errors are known immediately, eligibility is automatically validated, user defined reports are available, and paperless Authorizations and Referrals.
Member Eligibility
How do I check member eligibility?
http://www.cencalhealth.org/for_providers/eligibility_verification.html
What is Share of Cost (SOC) and how do I apply it?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/V/SOCFAQ.pdf
Where do I find information on Eligibility?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/V/EligibilityFAQ.pdf
Authorizations
How do I begin using online Authorizations? A username for the
www.cencalhealth.org website and a valid email address for authorizations is required to utilize the online Authorizations feature. For more information reference the
CenCal Health website guide
http://www.cencalhealth.org/for_providers/manuals.html or call Provider Services to speak to the Resource Specialist at 805.685.9525/800.421.2560 ext
1671.
How do I check the status of an Authorization?
Located on our Restricted Site the Authorization Report
will allow a provider to see what and how many
authorizations were submitted for a member, when it was
submitted, and its status.
You may also contact the following for:
Treatment Authorization Requests (TARs)
----------------------------(805) 682-1631
(805) 685-1632
(805) 685-1633
DME Authorization Requests
----------------------------------------------(805)
685-1641
RadConsult (Authorizations for high tech imaging
services) --- (888) 318-0276
What are electronic Referral Authorization Forms (eRAFs) and what are the benefits?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VII/FAQsaboutRAFs.pdf
When are RAFs NOT required?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VII/WhenRAFsAreNotRequired.pdf
How do I obtain a RAF from the PCP?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VII/FAQsaboutRAFs.pdf
How do I obtain a Treatment Authorization Request (TAR)?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VIII/AuthorizationMedicalServicesDME.pdf
When do I need a TAR?
http://www.cenclhealth.org/for_providers/procedures_TAR/tar_required.html
Pharmacy
Where do I get a Medication Request Form (MRF) form? This form is available in the restricted section of
www.cencalhealth.org or call Provider Services at 805.685.9525/800.421.2560 ext
1671.
How do I contact MedImpact, Pharmacy Benefit Manager?
ROUTINE QUESTIONS
Customer Service: (800) 788-2949
Routine Operational Issues
MAC QUESTIONS
Email: MAC@medimpact.com
Phone: (800) 788-2949
All MAC issues including pricing
URGENT QUESTIONS
Pharmacy Network Operations: Katherine St. John -(858) 790-6672
Website: www.medimpact.com/contact_pno.asp
For questions which need immediate/urgent attention.
Where is the
CenCal Health Formulary?
http://www.cencalhealth.org/for_providers/formulary/index.html
Where do I get assistance with clearing a Prescription SOC?
Contact Stephanie, Pharmacy Tech at ext 1647 or Lucy, Claims Supervisor at extension
1034.
Claims
What are Explain Codes and where do I obtain a list?
An explain code list is available in the restricted section
of
www.cencalhealth.org
What is a Medi- Reservation and how do I complete one?
This refers to the method of limiting the Medi-Services (or "Limited Services*") allowed under the Medi-Cal program, whereby a member is entitled to two services per month; these services include acupuncture, chiropractic, audiologist services, and physical therapy services. *Limited services do not require PCP authorization, but are limited to a total of two per month under the Medi-Cal program. Special authorizations needed from
CenCal Health to exceed this limit.
Where do I find a list of current modifiers?
Go to www.medi-cal.ca.gov from the bar on the right select "Medical Services." The new screen prompts you to enter search criteria. Enter "modifiers" Select the modifiers that fit the procedure.
Where are the online manuals?
CenCal Health at
http://www.cencalhealth.org/for_providers/manuals.html
Medi_Cal at
http://www.medi-cal.ca.gov
How do I contact a Claims Representative?
http://www.cencalhealth.org/contact_us/index.html
How do I find assistance understanding my Explanation of Benefits (EOB)?
http://www.cencalhealth.org/contact_us/index.html
contact a claims rep by your provider type
How do I find assistance with Claims?
http://www.cencalhealth.org/contact_us/index.html contact a claims rep by your provider type
Where do I send my claims?
CenCal Health
P.O. Box 1818
Bellflower, CA 90707-1818
What member number do I use on my claim?
For those providers who currently submit paper claims or
claims through electronic files, CenCal Health will
continue to accept the CIN or the Meds ID; however,
these forms of claim submittals will eventually be
converting to CIN as well. If you have the
member's CIN, you should begin using it.
Which number on the BIC card do I use?
The
ID Number also known as CIN Number is what should be
printed on the claim.
Become a provider
How do I become a provider with the Authority?
http://www.cencalhealth.org/for_providers/contracting/index.html
How do I become a Medi-Cal provider?
http://www.cencalhealth.org/for_providers/contracting/index.html
How do I find more information about workshops and trainings? Call Provider Services at 805.685.9525/800.421.2560 ext
1676.
Supplies/Services
How do I obtain a supply of forms?
Claim Forms: http://www.medi-cal.ca.gov
Order TARs:
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VIII/OrderingTARs.pdf
Order RAFs:
http://www.cencalhealth.org/for_providers/provider_manual/pdf/VII/OrderingRAFs.pdf
Order MRFs: This form is available in the restricted section of
www.cencalhealth.org.
Where can I find the current Contracted Provider List (CPL)?
http://www.cencalhealth.org/for_providers/contracting_provider_list/index.html
How do I obtain interpreter services? (Foreign language or for the deaf)
http://www.cencalhealth.org/for_providers/provider_manual/pdf/V/LanguageServicesSBRHAMembers.pdf
General Misc.
Where can I apply a Share of Cost (SOC)?
You may access these features under our Transaction
Services Restricted Section, you must have a valid
username and password. If you do not have one and
are interested in accessing CenCal's electronic data
forms pages, please contact the webmaster at
webmaster@cencalhealth.org.
Where can I find more information about coordinating Mental Health Services?
http://www.cencalhealth.org/for_providers/provider_manual/pdf/IIA/SpecialtyMentalHealthServices.pdf
ADMHS Referral Form:
http://www.cencalhealth.org/for_providers/provider_manual/pdf/IIA/ADMHSReferralForm.pdf
Does CenCal health administer Dental Benefits?
No, dental services are covered thru the Denti-Cal
Program for Medi-Cal and Delta Dental for non Medi-Cal.
How can I obtain a copy of my PCP Case Management List?
Case management reports are available in the restricted
section of http://www.cencalhealth.org or call Provider Services at 805.685.9525/800.421.2560 ext
1671 for assistance.
How do I clear a Share of Cost through the Automated Eligibility Verification System (AEVS)?
The Automated Eligibility Verification System (AEVS) is an interactive voice response system that allows you the ability – through a touch-tone telephone – to access recipient eligibility, clear Share of Cost liability and/or reserve a Medi-Service. There is no enrollment requirement to participate in AEVS. Providers must use a valid Provider Identification Number (PIN) to access AEVS at 1-800-456-AEVS (2387).
AEVs SOC Phoneline |
