Partnership Healthplan Of California Medi-Cal Provider Manual Claims Department (Page 3 of 3) in pdf

Partnership Healthplan Of California Medi-Cal Provider Manual Claims Department Page 3

4. Subject to Audit: We hope and expect that our obstetrical providers will bill for

these services appropriately, but to help assure medical necessity, Partnership will

audit in two ways. Practices with a high percentage of patients with extra visits

will have a random selection of charts audited to confirm Medical Necessity. IN

addition, Partnership will audit prenatal visit volume on a 6 month frequency. If

lack of Medical Necessity is found in the chart audit, the provider will be subject

to further action, including but not limited to retroactive denial of claims found to

lack medical necessity and lose the ability to bill for prenatal visits 11-15 without

prior authorization.

PHC Medi-Cal Provider Manual – Section 3, Sub-section X.L.

Page 3

Partnership Healthplan Of California Medi-Cal Provider Manual Claims Department Page 3