Medi-Cal Reimbursement (Conlan) Filing Instructions
REIMBURSEMENT PROTOCOL: The DHCS 4521 (Conlan Claim) is the legal mechanism for requesting a refund when you paid out-of-pocket for services Medi-Cal should have covered. Claims are processed by the DHCS Beneficiary Service Center (BSC).
Call for status updates or to request a physical form packet.
To prevent administrative "loss" of your documents and establish a verifiable timeline, the Rig recommends the following protocol:
blue or black ink only original form with your original signature — Photocopies, scans, or digital signatures will be rejected by DHCS — they require wet-ink authentication
USPS Certified Mail with Return Receipt — This gives you a tracking number and a physical signature confirming delivery. This is your primary weapon if DHCS misses their 120-day review window.
NEVER Send your only copy. Make a full photocopy or clear digital scan of every page of your signed packet, every receipt, and the envelope before you seal it. Retain these for your personal audit record.
If the direct PDF links fail, use the **Official Conlan Portal** to access the digital version of the packet.
REQUIRED FORMS:
PROOF OF PAYMENT (ONE OF):
Claims must be received within 1 year of the date of service, OR within 90 days of receiving your BIC card—whichever is later.
ESTIMATED PROCESSING: Review takes up to 120 days. If the provider refuses to refund you within 30 days of approval, the State will **involuntarily recoup** the funds from the provider's future payments and mail you a check.
RX HELPLINE: 1-800-977-2273
DENTAL CLAIMS: Use a separate address. Call the BSC at (916) 403-2007 to verify the current dental mailing portal before sending documents.