Request an assessment PAYER GUIDE
Medi-Cal and Medi-Medi: plan-level confirmation is essential.
California is not a separate version of Medicare. Medicare rules are federal; Medi-Cal and Medi-Medi arrangements add California program, county, managed-care-plan, network, and contract considerations.
Review a California payer mixHOW TO FRAME THE REVIEW
Do not rely on a national RPM assumption for a California member.
For Medi-Cal, Medi-Medi, or managed-care members, confirm the individual plan’s current policy and the organization’s actual payment arrangement before committing staff time, devices, or patient messaging.
Identify the patient’s county, Medi-Cal or Medi-Medi status, managed-care plan, and network.
Confirm whether the relevant work is paid under a fee-for-service, delegated, capitated, or other contractual model.
Check current plan policy, authorization, provider eligibility, device, documentation, and billing instructions.
Make patient communication and a clear escalation pathway part of enrollment—not an afterthought.
CALIFORNIA CONTEXT
Medi-Medi integration changes the conversation for some members.
California’s Medi-Medi Plans integrate Medicare and Medi-Cal benefits for eligible members in participating counties. That can change the plan and contracting questions a practice needs to resolve.
View DHCS Medi-Medi Plan informationDESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
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