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)

Doula services support our members throughout the pregnancy, during labor and delivery, after birth, and up to one year postpartum. And doula services are available for pregnancies that end in stillbirth, miscarriage, or abortion.

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.

What Services Are Included

• A 90-minute initial visit
• Up to eight additional visits, including pre- and post-birth visits. All visits are limited to one per day, per member.
• Support during labor and birth
• Up to two additional visits after birth to discuss breast feeding, mental health, and other concerns. Visits last up to 3 hours.

Note: State Standing Order for Recommendation for Services:

The Department of Health Care Services (DHCS) issued a statewide standing recommendation that all Medi-Cal members who are pregnant or were pregnant within the past year would benefit from receiving doula services from a Medi-Cal enrolled doula provider. The recommendation fulfills the federal requirement for a physician or other licensed practitioner of the health arts acting within their scope of practice to provide a written recommendation for preventive services.

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

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 Valley (PDF)
• DHCS recommendation form (PDF)

Providers can bill through claims submission or invoice submission.

Important note: Authorization number is not a required field for billing.

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

• Electronic data interchange (EDI) (preferred)
• Availity Essentials
• Bill by invoice – Please contact your assigned Point of Contact.
• Submit paper CMS-1500 (version 02/12) form for paper claims. Note: Using this method may take additional time.
  
  Refer to the Claims Procedures section for more information.
  • Address:
    Health Net – CalAIM Invoice
    PO Box 10439
    Van Nuys, CA 91410-0439
  • Fax: 833-386-1043

Billing training

To learn more about how to bill for doula services, refer to the Claims and Invoice for Providers training: CalAIM training > Required Onboard Trainings