CHDP Gateway to Health Coverage

May 2017 | Bulletin 151

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2. Providers to Report PPCs Using DHCS Secure Online Portal

Effective June 1, 2017, the Department of Health Care Services (DHCS) will no longer accept paper forms for reporting provider-preventable conditions (PPCs). DHCS began accepting online reporting of PPCs for Medi-Cal on April 3, 2017. The development of secure online submission is in response to provider requests to make PPC reporting easier. This new online process replaces the paper Medi-Cal Provider-Preventable Conditions (PPC) Reporting Form (DHCS 7107). The secure online reporting portal is available on the Instructions for online reporting of PPCs Web page of the DHCS website.

Providers must report health care-acquired conditions (HCACs) when they occur in an acute hospital inpatient setting, and report other provider-preventable conditions (OPPCs) when they occur in any health care setting, according to state law in Welfare and Institutions Code (W&I Code), Section 14131.11, as well as the Code of Federal Regulations (CFR) Title 42, Sections 434, 447 and 438. Providers must report PPCs for any Medi-Cal recipient when any PPC occurs that did not exist prior to the provider initiating treatment, even if the provider will not seek Medi-Cal reimbursement to treat the PPC.

More information about PPC reporting requirements, PPC definitions and mandatory payment adjustments is available on the Medi-Cal Guidance on Reporting Provider-Preventable Conditions Web page of the DHCS website. Providers may email questions about the new PPC process to PPCHCAC@dhcs.ca.gov.

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3. CHDP Phase 2: HIPAA Code Conversion and Claim Form Transition

Effective for dates of service on or after July 1, 2017, the two-digit local procedure codes currently used for Child Health and Disability Prevention (CHDP) program claims are discontinued. The codes will be replaced with national HCPCS procedure codes and modifiers that comply with HIPAA requirements.

The CHDP Confidential Screening and Billing Report (PM 160) claim form will no longer be used to bill for CHDP Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessments, immunizations and ancillary services for dates of service on or after July 1, 2017. For these dates of service, qualified Medi-Cal providers enrolled in the CHDP program must bill CHDP/EPSDT services on a CMS-1500, UB-04 claim form or electronic equivalent. Providers should note the national codes cannot be submitted on the PM 160.

Code Conversion Table: To view the full code conversion and additional instructions, providers may refer to the CHDP Code Conversion Table. Updated manual sections will be released in future CHDP Update and Medi-Cal Update bulletins.

This is Phase 2 of the CHDP transition to national codes and claim submission methods. Phase 1, which was effective February 1, 2017, was for CHDP providers submitting claims for laboratory-only services. To see what was published for Phase 1, providers may refer to the article CHDP HIPAA Code Conversion for Clinical Laboratory Service Providers Coming Soon.

Facts about both Phase 1 and Phase 2 are available on the CHDP Frequently Asked Questions page of the Medi-Cal website.

Providers are encouraged to watch for CHDP updates in the NewsFlash area on the Medi-Cal website, and subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to CHDP by completing the MCSS Subscriber Form. Providers with questions or concerns may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Email Address for Questions/Concerns
Providers may submit questions or concerns regarding the CHDP code conversion and claim form transition to CHDPTransition@conduent.com.

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4. June 2017 Medi-Cal Provider Training Webinars

Beginning June 1, 2017, and continuing throughout the month of June, Medi-Cal providers may participate in provider training webinars:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have Internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach and Education page of the Medi-Cal website.

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