This number identifies the provider through the Medi-Cal claims processing system. As CMHS provides the billing service on behalf of physicians, these identifiers must be current and on file. CMHS Provider Relations will maintain a current Provider Database containing Medi-Cal PIN information. Claims for eligible services provided by staff at a certified Provider site require this authorization number. The Medicare fiscal intermediary has established a general protocol that limits the reimbursement for physician visits to 20 physician visits per year on average.
Additional visits are subject to demonstrating medical necessity through documentation.
The purpose of such monitoring is, when applicable, to maximize reimbursement by Medicare as the primary payor source at SF City and County and contract agencies. MediCal reimbursement for physician visits will be monitored and managed through the outpatient consolidation authorization and reauthorization medical necessity criteria. Client Death Claims submitted for services provided after a client death will be denied by Medicare and MediCal.