Cal. Code Regs. tit. 9 § 1850.325

Current through Register 2024 Notice Reg. No. 49, December 6, 2024
Section 1850.325 - Provider Appeal Process - Claims Processing

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.

Cal. Code Regs. Tit. 9, § 1850.325

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.

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).