Doula End-to-End Process

The member must be active and enrolled in the Medi-Cal Plan. Confirm member eligibility for the month of service through either of the following:

• Provider portal (preferred method). Log in to the secure provider portal, then select Eligibility.
• Automated Eligibility Verification System: 800-456-2387
  The Automated Eligibility Verification System (AEVS) is available from 7:00 a.m. to 8:00 p.m., seven days a week. To access this automated network, providers will need their Medi-Cal Provider Identification Number (PIN).

If you are a provider who currently does not have access to the portal, refer to the below brochure for instructions on how to register:

• Save Time Navigating the Provider Portal brochure – Health Net (PDF)
• Save Time Navigating the Provider Portal brochure – CalViva Health (PDF)
• Save Time Navigating the Provider Portal brochure – Community Health Plan of Imperial Valley (PDF)

Doulas will contact members to schedule an appointment.

Doula services include personal support to women and families throughout a woman's pregnancy, childbirth, and postpartum experience. This includes emotional and physical support, provided during pregnancy, labor, birth, and the postpartum period.

Refer to the CS workflow to identify member needs and confirm if they qualify for Community Supports services.

Follow these steps:

• I am an ECM provider – refer to the ECM workflow
• I am not an ECM provider – refer to step 2 of the ECM workflow

If the member qualifies for CS services, refer to the CS workflow for referral information.

Recommendation – Additional visits during the postpartum period require a recommendation. A doula may facilitate obtaining recommendation from any licensed practitioner for the member.

We will accept either Health Net or DHCS forms:

• Medi-Cal Member Recommendation for Doula Services – Health Net (PDF)
• Medi-Cal Member Recommendation for Doula Services – CalViva Health (PDF)
• Medi-Cal Member Recommendation for Doula Services – Community Health Plan of Imperial ValleyHealth (PDF)
• DHCS recommendation form

Document doula services and put in the member medical record. Be prepared to present documentation to DHCS or Health Net, if requested. Use the form:

• Medi-Cal Doula Services Documentation of Doula Visit – Health Net (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – CalViva Health (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – Community Health Plan of Imperial Valley (PDF)

Any documentation format that meets DHCS documentation of services requirements will be accepted.

Providers can bill through claims submission or invoice submission. Note: if you submit claims, you won't have to submit an invoice and vice-versa.

Submit claims or invoice forms and supporting information to one of these options:

• Electronic data interchange (EDI) through a clearinghouse or Availity (recommended).
• Submit paper CMS-1500 (version 02/12) form for paper claims. Refer to the Claims Procedures section for more information.
• Bill by invoice. (Download the Invoice form)
  Note: Payor Primary ID for HNT and CVH is 95567.
  
  
  • Email: CalAIM_CS_invoicesubmission@centene.com
  • Address:
    Health Net – CalAIM Invoice
    PO Box 10439
    Van Nuys, CA 91410-0439
  • Fax: 833-386-1043
  • Conduent Web Portal

Note: All visits are limited to one per day, per member. Only one doula can bill for a visit provided to the same member on the same day, excluding labor and delivery. One prenatal visit or one postpartum visit can be provided on the same day as labor and delivery, stillbirth, abortion or miscarriage support. The prenatal visit or postpartum visit billed on the same calendar day as birth can be billed by a different doula.

The extended three-hour postpartum visits provided after the end of pregnancy do not require the member to meet additional criteria or receive a separate recommendation. The extended postpartum visits are billed in 15-minute increments, up to three hours, up to two visits per pregnancy per individual provided on separate days.

Billing training

To learn more about how to bill for doula services, refer to the Claims and Invoice Guidance training.

Note: The training deck is available after viewing the training video.