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A Medi-Cal file is what you upload in the Medi-Cal Provider Portal. A test file is free and is how you prove yourself to Medi-Cal. A production file is the real submission and uses credits.

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Make the file

1

Choose the claims

In Your claims, tick the claims. A file takes between 1 and 500 claims. For a single claim you can skip the tick: select the ⋯ menu at the end of its row and choose Generate file…. A draft shows it greyed out, with “Mark it ready first”; a claim with problems to fix shows it greyed out, with “Fix N problems first”.
2

Select Generate

The button reads Generate with the number ticked. The arrow beside it opens a menu with Approve for the same claims. The Make a Medi-Cal file sheet opens: “N claims chosen.”
3

Choose Test file or Production file

Test file is free. Production file is “the real submission. Only approved claims go in. It uses credits, once for each claim the first time it goes in a file.” Production is greyed out until you have the permission and Setup shows production; the sheet says why and links to Open Setup.
4

Read the summary

The sheet shows Claims, Credits per claim, Credits this file uses and Credits the clinic has. If the balance is short it says “This file needs N credits and the clinic has M. Buy at least X more.” with Buy credits. Buy credits opens the Buy clinical credits panel on top of the sheet: it shows what the file needs, what the clinic has and how many more you need, marks the smallest pack that covers it, and shows any volume bonus. Choose a pack, select the Buy button (it names the credits and the price) and pay with Stripe. After paying you come back to Medi-Cal Claims with a “Payment received” message, and the sheet opens again with the same claims ticked. If you cancel the payment, nothing is charged and the sheet stays closed. Your credits appear as soon as the payment is confirmed, and the sheet then shows the new balance. Only an owner or manager can buy credits; anyone else reads “Ask the clinic owner or a manager to add credits.”
5

Look at the code checks

Code checks says how many of the claims have code warnings, with Open claim links. Warnings never stop a file.
6

Select Make test file or Make production file

The button reads Making the file… while it works. When it is done the sheet reads Test file made or Production file made, with the number of claims and, for production, “N credits used; M left.”

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What a file costs

A production claim costs credits once, the first time it goes into a file. Making the file again with a claim that was already charged does not charge it again. The first re-filed copy of a claim Medi-Cal turned away before processing it is free: see Corrected claims and voids. One credit is one cent, so 25 credits is $0.25. The same figures show as Claim in a Medi-Cal file under Metered Activity on the Subscription tab. Test files are free on every plan. Buy credits in Clinical credits.

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The Free plan’s monthly limits

On the Free plan the home page shows “This month on Free” with your counts and Upgrade plan, and the sheet shows Free plan, this month. Each month, resetting on the 1st: A free re-file of a claim Medi-Cal turned away does not count towards the 25 production claims, but its file counts as a production file. A paid plan has none of these limits, only the per-claim credits. At a limit the file is refused with “The Free plan limit is reached”, nothing is charged, and nothing already made is lost.

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Download it and upload it to Medi-Cal

1

Download the file

Select Download on the done screen, or open Files and select Download beside the file. The links stop working after a few minutes; select Download again for new ones. On the Free plan the count shows, for example “Downloads used: 1 of 3”.
2

Keep the file as it is

Do not open it and save it. Opening and saving can change it.
3

Sign in to the Medi-Cal Provider Portal

Go to Transaction Center, then EDI Submission.
4

Submit it

Choose the file and submit it. A test file goes in as a test; a production file goes in as a real submission.
5

Read Medi-Cal's reply report

The reply report tells you what was accepted or rejected. A test file is checked the same way, so its report is the proof for your 10-claim test. Add a production file’s reports under Reports to see each claim’s result and update its status.
A production file uses credits and is meant to be uploaded to Medi-Cal as it is. Check the claims and the credits in the summary before you select Make production file.
Some files show Worth knowing notes after they are made. Read them before you upload.

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Who can do this

Making a test file needs no permission. Making a production file needs Make production Medi-Cal files, which owners and managers always have and other staff only when it is given. See Approve claims.

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Check it worked

  • The sheet says Test file made or Production file made.
  • Files lists it with its Kind (Test or Production), when it was Made, Claims and Downloads used.
  • Production claims now read In a file, and the credit balance on the Subscription tab has gone down.

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Common issues

“A production file uses clinical credits. It needs N credits and the clinic has M. Nothing was charged. Select Buy credits in the sheet, add a pack, then make the file again.” See Clinical credits.
“The Free plan allows N of these a month and this clinic has reached that. The count starts again on the date shown. A paid plan has no monthly limit. Nothing was charged.” Choose Upgrade plan, or wait for the reset.
The Free plan allows 3 downloads of each production file. Upgrade your plan to remove the limit.
Open the claims listed, fix each reason and make the file again. A claim that looks like one already filed needs a corrected claim: code 7 in box 22 and the 13-digit original claim number. See Corrected claims and voids.
“Confirm and mark every claim ready, then try again. Nothing was charged.” For a production file, approve them too.
“Check the Files screen before trying again, so the same claims are not charged twice. Do not retry until you have looked.”
“Making a production file needs permission at this clinic. Ask an owner or manager. A test file does not need it.”
A file holds up to 500 claims. Make two files with fewer claims each.

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FAQ

No. You upload it yourself in the Provider Portal. ClinikEHR has no clearinghouse and cannot see your Portal account.
Test claims are not paid by Medi-Cal, and Medi-Cal asks every new submitter to send at least 10 test claims for each claim type first. Test files are free so you can do that.
Sometimes not. If the claims cannot go together the sheet says “These claims cannot go in one file. Make the file from fewer claims, or from one billing provider at a time.”