Fee for Service Providers
This page is a resource for obtaining Medi-Cal documentation trainings, Specialty Mental Health Services (SMHS) treatment authorizations and other supportive provider materials
(800) 798-2254
Hours of Operation: Mon. - Fri. 8:00 a.m. - 5:00 p.m.
Provider Resource Materials
Select a category below to find additional materials.
Applications
New Provider Requirements
Beneficiary Materials
CANS/PSC
- CANS Instructions and Process (pdf)
- CANS User Guide (pdf)
- CANS-PSC Completion Tip Sheet with link to Tools (pdf)
- CYF mHOMS Client Information Sheet (pdf)
- Electronic CANS & PSC Resources (pdf)
- Electronic CANS Form (pdf)
- Electronic CANS Form – Early Childhood Version (pdf)
- Electronic PSC - Parent Form (pdf)
- Electronic PSC - Parent Form - Spanish (pdf)
- Electronic PSC - Youth Form (pdf)
- Electronic PSC - Youth Form - Spanish (pdf)
Claims
Communications & Updates
2022 Communication/Updates
2021 Communication/Updates
Archived Communication/Updates
- Microsoft Word - Optum Response to Presumptive Transfer Inquiries in SD -3.9.18
- Mild-Moderate-Severe FAQs (pdf)
- Outpatient Authorizations for Continuing Services during COVID-19 (pdf)
- Telephone Telehealth Approved Notification (pdf)
- Therapeutic Behavioral Services Prior Authorization Request & Referral Process (pdf)
Compliance
Provider Newsletter
Provider Services
Provider Services
Provider Information
Resources to Assist & Inform Medi-Cal Members' Health Care Choices
Review - Inpatient
Review - Medication Quality Assurance
Review - Outpatient
- Beneficiary Materials MHP Order Form (pdf)
- DHCS Reasons for Recoupment FY 19-20 (pdf)
- DHCS Reasons for Recoupment FY 20-21 (pdf)
- DHCS Updated Reasons for Recoupment FY 21-22 (pdf)
- Documentation Tip Sheet (pdf)
- Initial Client Checklist (pdf)
- Pre-Credentialing_Site_Review_Tool_(pdf)
- Reasons for Recoupment Quick Guide FY 18-19 (pdf)
- Record Keeping and Treatment Record Requirements (pdf)
- Site Review Tool (pdf)
- Treatment Record Review Tool (pdf)
SMHS Authorization Requests
- Ancillary Specialty Mental Health Services Request (docx)
- Demographic Form Fill (docx)
- Demographic Form Minimum Necessary Fields (pdf)
- ECT Authorization Request Form (pdf)
- Interpreter Services Request Form (pdf)
- MFT Eligibility Verification Form (pdf)
- Outpatient Authorization Request Form Therapists (docx)
- Outpatient Authorization Request Form Therapists (pdf)
- Outpatient Authorization Request Form Therapists Example (pdf)
- Outpatient Authorization Request Form Therapists Minimum Necessary Fields (pdf)
- Outpatient Authorization Request Psychiatry Form Fill (pdf)
- Outpatient Authorization Request Psychiatry Minimum Necessary Field (pdf)
- Outpatient Authorization Request Psychiatry Word (docx)
- Psych Testing Request Form (docx)
Templates and Examples
For Prescribers Only Templates
- Med Management Progress Note (docx)
- Med Management Progress Note (pdf)
- Med Management Psychotherapy Note (docx)
- Med Management Psychotherapy Note (pdf)
- Med Management and Psychotherapy Note (docx)
- Med Management and Psychotherapy Note (pdf)
- Psychotropic Medication Informed Consent Guide (pdf)
- Treatment Plan and Informed Consent for Psychotropic Medication (pdf)
- Treatment Plan and Informed Consent for Psychotropic Medication (docx)