CHDP Gateway to Health Coverage

March 2017 | Bulletin 149

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1. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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2. Update: DHCS Fiscal Intermediary Name Change

Effective immediately, providers may notice that the Department of Health Care Services (DHCS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly Xerox State Healthcare, LLC (Xerox), is operating under a new company name, “Conduent.” Providers may also see the Conduent logo on some items.

Operations and interactions with providers are not impacted by this FI name change.

Providers may see this name change in items such as:

  • NewsFlash articles and Medi-Cal Update bulletins
  • Medi-Cal website (www.medi-cal.ca.gov)
  • Forms and User Guides
  • Provider Manuals
  • Medi-Cal Learning Portal (MLP)
  • Presentations at Provider Training Seminars
  • Provider Letters, such as Erroneous Payment Corrections (EPCs)
  • Additional hard copy correspondence
  • Emails with an “@conduent.com” address rather than an “@xerox.com” address
  • References to the Conduent name when researching mailing addresses or published telephone numbers
Conduent logo

There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same.

Medi-Cal providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to Medi-Cal Update bulletins, NewsFlash articles, and System Status Alerts. Providers may sign up for MCSS by visiting http://www.medi-cal.ca.gov and completing the MCSS Subscriber Form. For more information about Conduent, visit https://www.conduent.com.

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3. Date for Final Phase of CHDP Transition Announced

The second and final phase of the Child Health and Disability Prevention (CHDP) program’s transition to billing with CPT-4 codes on the CMS-1500 or UB-04 claim form, or electronic equivalent, will be effective for dates of service on or after July 1, 2017. This date is posted on the CHDP Frequently Asked Questions (FAQ) Web page of the Medi-Cal website.

In addition, ten questions and answers have been added to the Web page’s “Miscellaneous Questions” section to address the Phase 2 transition.

  1. Will providers currently billing for CHDP services be able to bill equivalent services for CHDP related Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessments and immunizations?

    CHDP approved providers are eligible to bill Medi-Cal for equivalent services for CHDP related well-child health assessments, immunizations and ancillary services rendered under the EPSDT benefit of the Medi-Cal program in accordance with the provider's Medi-Cal enrollment status, for example, Medi-Cal provider type and category of service.

  2. Will my payments come on the Medi-Cal Warrant or on a separate checkwrite?

    For services provided prior to the transition processed in the CHDP subsystem, the provider will not notice a change. For any services provided on or after the transition date of July 1, 2017, claims will be adjudicated in the Medi-Cal system and reimbursements will be reflected in the provider's Medi-Cal warrant.

  3. When billing with the CMS-1500 form, will providers be required to provide the parent and county office a copy of the health assessment as is done with the CHDP Confidential Screening/Billing Report (PM 160) forms?

    It will no longer be necessary to provide the county office a copy of the claim form. The health assessment provider should provide the child, parent or guardian with the results of the health screening and evaluation and an explanation of the meaning of the results.

  4. The current PM 160 form has fields for clinical results as well as other information that is not currently captured on the CMS-1500, UB-04 or ANSI 837P/837I form. Will there be specific information about where to put that information on those forms or formats?

    The ANSI 837P/837I electronic claims and the corresponding claim forms and completion instructions will not be modified to accommodate the fields on the PM-160 form that do not appear in the national standard electronic transactions and claim forms. Providers will document the clinical data in the patient's records.

  5. With the CHDP conversion to the CMS-1500 form, what is the status with the Body Mass Index, Hemoglobin, Hematocrit, Tobacco and other additional fields?

    Providers will be expected to perform these tests as indicated on the “CHDP Bright Futures Schedule for Health Assessments by Age Group” PDF. However, it is no longer required to include these metrics on the claim form.

  6. Which signatures and National Provider Identifierss (NPI) are required when billing on the CMS-1500 form?

    The claim must be signed and dated by the provider or representative assigned by the provider.

  7. Do providers need to fill out the service facility location information?

    Yes. Enter the provider name and address of the facility where the services were rendered, including the nine-digit ZIP Code.

  8. Does the billing providers information need to be included?

    Yes. The provider name and address must be entered without a comma between the city and state, including the nine-digit ZIP Code, without a hyphen, and the telephone number and the provider's NPI.

  9. Which signatures and NPIs are required when billing on the UB-04 form?

    Provider name, address and ZIP code are required including the city and state with nine-digit ZIP code.

  10. Will new Medi-Cal providers interested in providing CHDP-related services have to apply to be a CHDP provider to use the CHDP gateway or render services in accordance with the Bright Futures Periodicity Schedule?

    Under the transition of CHDP claims adjudication, CHDP providers are required to be enrolled as Medi-Cal providers and approved as CHDP providers. This enables providers to submit claims for CHDP EPSDT well-child health assessments, immunizations and ancillary services to Medi-Cal, and to enroll youths in presumptive eligibility Medi-Cal through the CHDP Gateway. CHDP services under the transition are Medi-Cal state plan benefits and conform to the AAP Bright Futures periodicity schedule and benefit guidelines. Claims for reimbursement for these services will be billed in accordance with Medi-Cal billing requirements, procedures and policies, and will be reimbursed at Medi-Cal rates. Providers will receive reimbursement for CHDP services on the Medi-Cal checkwrite.

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4. Aid Codes for the Medi-Cal County Inmate Program

Effective for dates of service on or after April 1, 2017, providers may submit claims for the Medi-Cal County Inmate Program (MCIP) with the following aid codes:

MCIP Program Aid Codes
Adult County Inmate Program (ACIP) F3, F4, G3, G4, N7, N8, N0
Juvenile County Ward Program (JCWP) G5, G6, G7, G8
County Compassionate Release Program (CCRP) and County Medical Probation Program (CMPP) J1, J2, J3, J4, J5, J6, J7, J8, K6, K7, K8, K9

The county may reimburse a Medi-Cal provider to the extent required or otherwise permitted by state and federal law to arrange for services for the MCIP-eligible inmate. Additional amounts will be paid entirely with county funds, and will not be matched with federal financial participation.

For additional information, providers can submit questions via email to DHCSIMCU@dhcs.ca.gov.

For eligibility-related questions regarding ACIP, JCWP, CCRP or CMPP, providers can contact the Medi-Cal Eligibility Division at MCIEP@dhcs.ca.gov.

For all mental health and psychiatric service-related questions regarding ACIP, JCWP, CCRP or CMPP, providers can contact the County Customer Services Section at MedCCC@dhcs.ca.gov.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
CHDP
Part 1
aid codes (6–9, 11, 12)
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5. April 2017 Medi-Cal Provider Seminar

The next Medi-Cal seminar is scheduled for April 25 – 26, 2017, at the Long Beach Marriott in Long Beach, California. Providers can access a class schedule for the seminar by visiting the Provider Training Web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and Conduent, the Fiscal Intermediary for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by April 11, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 11, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page of the Medi-Cal website.

Note:  Wi-Fi will not be provided at the seminar, please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training Web page and refer to it often for current seminar information.

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