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Department of Health Care ServicesState of CaliforniaHealth and Human Services AgencyQUALIFIED MEDICARE BENEFICIARY (QMB)/SPECIFIED LOWINCOME MEDICARE BENEFICIARY (SLMB)/QUALIFYING INDIVIDUAL (QI) ELIGIBILITY.

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Original (or initial) Medi-Cal claims must be received by the FI within six months following the month in which services were rendered. This requirement is referred to as the six-month billing limit.

Retroactive coverage protects patients and providers by ensuring that medical bills are paid even if a Medicaid application is not filed until the calendar month following a traumatic event. Federal Medicaid law allows some providers, like hospitals, to determine certain people presumptively eligible for Medicaid.

MC 604 IPS (5/14) Tell Us About Your Income And Expenses. Tell us about your income and expenses for you, your spouse and any of your children under 21 years of age who are living in the home, or are temporarily absent from the home for reasons such as attending school or work or is hospitalized.

However, this may take a long time . If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare . Medicare may make a conditional payment to pay the bill, and then later get back any payments the primary payer should have made .

Medi-Cal renewal happens throughout the year, occurring on the anniversary of your enrollment in Medi-Cal. If members of your household have Medi-Cal, they will receive a Medi-Cal renewal form from their local county human services agency.

Each year, your county will conduct a review to determine if you and/or your family members continue to meet Medi-Cal eligibility requirements. This review process is called your annual redetermination.

Retroactive Medi-Cal covers unpaid medical expenses from the three months prior to the month you apply for Medi-Cal. If you have unpaid bills from the three previous months, enter that information during the application process. If you qualify for Medi-Cal, you will also be evaluated for retroactive coverage.

To bill Medi-Cal, a provider must complete the appropriate enrollment forms. For questions on which forms to use, contact the Out-of-State Provider Unit at (916) 636-1960. If a provider chooses not to enroll, they may bill the patient.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232