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CHDP Proprietary Electronic Claim Transaction Format Update

October 8, 2014

Effective December 22, 2014, the Child Health and Disability Prevention (CHDP) program's proprietary electronic claim transaction format will be modified to accommodate a billed amount field expansion. Providers who submit electronic CHDP claims may use the existing (current) format or the new expanded billed amount field format. However, providers must submit the claim in the new expanded billed amount field format in order to receive Patient Protection and Affordable Care Act (ACA) enhanced payments for eligible CHDP services if the billed amount for the service is greater than $99.99.

The billed amount field for tests and immunization will be expanded from four positions (99v99) to five positions (999v99) and the total fees billed amount will be expanded from five positions (999v99) to six positions (9999v99) in the new format.

The following billed amount fields will be expanded:

  • History and Physical Billed Amount
  • Snellen or Equivalent Billed Amount
  • Audiometric Billed Amount
  • Hemoglobin or Hematocrit Billed Amount
  • Urine Dipstick Billed Amount
  • Complete Urinalysis Billed Amount
  • TB Mantoux Billed Amount
  • Other Tests Billed Amount-1
  • Other Tests Billed Amount-2
  • Other Tests Billed Amount-3
  • Immunization Billed Amount-1
  • Immunization Billed Amount-2
  • Immunization Billed Amount-3
  • Immunization Billed Amount-4
  • Immunization Billed Amount-5
  • Immunization Billed Amount-6
  • Immunization Billed Amount-7
  • Total Fees Billed Amount

The total length of the format remains the same; however, the field positions will be shifted to accommodate the expanded billed amount fields. For additional information, providers may refer to the version of the billed amount field format in Claim Type 11 (CHDP) Claim Record Data Specifications section.

The Claim Type 11 (CHDP) Claim Record Data Specifications section of the Computer Media Claims (CMC) Billing and Technical Manual will be modified to include the newly expanded billed amount field format and the changes above. The updated section will be released in a future Medi-Cal Update.