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Targeted Rate Increase

Effective January 1, 2024, the California Department of Health Care Services (DHCS) increased reimbursement rates for certain Medi-Cal covered physician services to no less than 87.5% of Medicare to advance access, quality, and equity for Medi-Cal members and promote provider participation in the Medi-Cal program.

Providers have the right to file a grievance regarding their TRI payment within 365 days of receipt. Please utilize the TRI Grievance PDR and submit to targetedrateincrease@iehp.org.

For questions regarding TRI, please contact IEHP Provider Call Center at 909-890-2054, 1-866-223-IEHP (4347) or providerservices@iehp.org.

Medi-Cal Learning Portal

The Medi-Cal Learning Portal provides extensive resources and a broad range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link:

 

By clicking on this link, you will be leaving the IEHP website.

 

Medi-Cal Rates and Codes

Medi-Cal Rates

The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system.

 

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CPT Codes

This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits.

 

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Alpha-Numeric HCPCS Files

These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.

 

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ZIP code To Carrier Locality File

This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS.

 

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Medicare Physician Fee Schedule

Information on services covered by the Medicare Physician Fee Schedule (MPFS).

 

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IEHP Fee Schedule

Provider Dispute Resolution and Provider Appeals Resolution Process

Provider dispute resolution process for contracted and non-contracted Providers

Provider appeals resolution process

Other Health Coverage (OHC)

Services Not Requiring Prior Authorization

Effective June 1, 2024, for all contracted Providers, IEHP shall waive the authorization requirement for Professional Routine Behavioral Health Services rendered by a Behavioral Health provider specialty billed with the Procedure Codes listed in the reference document below:

 

Billing Code Guidelines

Thank you for being a valued partner in providing high quality care to your patients. Periodically, billing codes are updated by regulatory agencies. These guidelines will provide current billing codes and specifications and should be reviewed regularly as billing guidelines may change.