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Mental Health Forms

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Medi-Cal Manual Claim Forms

MC 1982 A: SD/MC Quarterly Claim for Reimbursement - Treatment Cost
MC 1982 B: Medi-Cal Specialty Mental Health Services Quarterly Claim for Reimbursement - Administrative Cost:

MC 1982 C: SD/MC Monthly Claim for Reimbursement - Quality Assurance/Utilization Review (QA/UR) Cost
MC 1982 D: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)
MC 1982 G: SD/MC Quarterly Claim for Reimbursement - Medi-Cal Administrative Activities (MAA)

BHIS Certification Forms

DHCS Application Portal Approval Forms

ITWS Certification Forms

Mental Health Certification Forms

Other Mental Health Forms

Last modified date: 3/16/2023 9:39 AM