CHDP Gateway to Health Coverage

August 2018 | Bulletin 166

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1. Phase 3: RTD Generation is Discontinued

The Department of Health Care Services (DHCS) has eliminated the generation of Resubmission Turnaround Documents (RTDs) (Form 65-1). The discontinuation of RTDs will both increase claims processing efficiency and reduce costs.

RTDs were discontinued in multiple phases. The first phase was implemented in November 2017 and the second phase was implemented in February 2018. The third and final phase was implemented in May 2018. The new process will deny claims submitted with questionable or missing information instead of generating an RTD. The generation of RTDs has been completely discontinued and providers will no longer receive RTDs.

The Resubmission Turnaround Document (RTD) Overview section of the Part 1 manual and the Resubmission Turnaround Document (RTD) Completion section of the Part 2 manual are retired. Additional references to RTDs in the Part 1, Part 2, CHDP and Family PACT manuals are removed as well.

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

Provider Manual(s) Page(s) Updated
Acupuncture
Chiropractic
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); remit adv (2, 3)
Adult Day Health Care Centers appeal form (2); cif sub (3); community ipc (5); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Aids Waiver Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Audiology and Hearing Aids
Durable Medical Equipment
Medical Transportation
Orthotics and Prosthetics
Psychological Services
Therapies
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
CHDP chdp trans (2)
Chronic Dialysis Clinics
Clinics and Hospitals
Rehabilitation Clinics
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Expanded Access to Primary Care Program
Heroin Detoxification
Multipurpose Senior Services Program
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Family PACT prov rel (2)
General Medicine
Obstetrics
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3)
Home Health Agencies/Home and Community-Based Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); ped (5); remit adv (2, 3); ub comp op (3); ub spec op (5)
Hospice Care Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); hospic ge (3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Inpatient Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp ip (3)
Local Educational Agency appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp op (3); ub spec op (5)
Long Term Care appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); pay ltc comp (6); remit adv (2, 3)
Part 1 0Cgetstart (3); claim sub (7, 11); cmc (4); elig rec (4); prov rel (2); prov tele (14); remit (2); remit and (1)
Pharmacy appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); pcf30-1 comp (14); pcf30-1 spec (1); remit adv (2, 3)
Vision Care appeal form (2); cif sub (3); cms comp vc (13); cms spec vc (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
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2. CHDP Phase 3 HIPAA Code Conversion: School-Based Services Crosswalk

The Department of Health Care Services (DHCS) is initiating Phase 3 of the Child Health and Disability Prevention (CHDP) claim form transition and code conversion. To comply with HIPAA national standards for health care electronic transactions and code sets, school-based services will transition to national standards in the fourth quarter of 2018.

CHDP school-based providers will bill services directly to Medi-Cal in accordance with HIPAA national standards. Services will be billed with CPT-4 national codes on the UB-04 claim form or electronic equivalent. Services billed on the incorrect claim form for the date of service will be denied.

In addition to meeting HIPAA standards, this transition adapts CHDP billing to the American Academy of Pediatrics (AAP) February 2017 Bright Futures periodicity schedule and enhanced Bright Futures services.

Code Conversion Table
The full code conversion is available in the CHDP Code Conversion Table.

CHDP Program
The CHDP program reimburses for outpatient preventive health services for eligible children and youth. In California, the CHDP program provides the early and periodic screening component of the federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for Medi-Cal recipients.

Billing and Reporting
It is recommended that providers plan to bill electronically. Providers who are not able to bill electronically and do not have a supply of national claim forms should order them. Providers should work with a credible vendor and purchase forms with “drop-out” ink that meet Centers for Medicare & Medicaid (CMS) standards.

Note:

To bill, CHDP providers must have an active Medi-Cal NPI.

Information submitted on UB-04 claim forms does not need to be forwarded to county CHDP offices, as was required with the CHDP PM 160.

For providers who are not actively billing on the UB-04 claim form, a claim completion, computer-based training (CBT) course is available through the Medi-Cal Learning Portal (MLP).

Reimbursement
CHDP/EPSDT services billed with national codes on the UB-04 or electronic equivalent are reimbursable at Medi-Cal rates. Reimbursement will be made on providers’ Medi-Cal warrant for claims processed with dates of service on or after the transition date.

At a Glance Differences
The following chart illustrates the differences between future and current CHDP practices:

School-Based providers will use: School-Based CHDP providers use: *
California Medicaid Management Information System (CA-MMIS) claims processing, which allows providers to check claim status during processing CHDP claim processing subsystem, which does not allow claim status checks during processing
HIPAA-compliant UB-04 claim forms Non-HIPAA-compliant Confidential Screening/Billing Report (PM 160) proprietary form
HIPAA-compliant ASC X12N 837I v.5010A2 electronic health care transactions Non-HIPAA-compliant CHDP computer media claims (CMC) electronic transactions
HIPAA-compliant CPT-4 procedure code(s) Non-HIPAA-compliant two-character CHDP local codes
Modifiers No modifiers (local codes are billed as full components)
Single claim line processing Whole claim processing
Remittance Advice Details (RAD) form with payment information for paper claims
or
ASC X12N 835 v.5010A1 Health Care Claim Payment/Remittance Advice (RA) with payment information for electronic claims
Non-HIPAA-compliant CHDP Remittance Advice (RA) with fee adjustment codes
Medi-Cal warrant for payment of services rendered CHDP Remittance Advice (RA) for payment of services rendered
Claims Inquiry Form (CIF) to request claim adjustments A new PM 160 to request balance due or adjustment
CIF to track submitted claim A new PM 160 to trace claim
Appeal Form (90-1) to challenge denials. Appeal reference number (ARN) to track appeal status. A new PM 160 to initiate the CHDP appeal process. (No ability to track appeal.)
* Items in this column apply for claims with dates of service prior to the transition of Phase 3.

Additional Information
For additional important information concerning this code conversion, refer to the already published article, CHDP Phase 3: School-Based Services Transition Coming Soon.

Providers are encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the upcoming changes. These notifications will inform and prepare providers to minimize unnecessary service disruptions. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Email Address for Questions/Concerns
Providers may submit questions or concerns regarding the CHDP Phase 3 school-based services code conversion and claim form transition to CHDPTransition@conduent.com. Including the following information will expedite a response to your inquiry: NPI number.

Manual replacement pages reflecting these changes will be released in a future CHDP Update bulletin.

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3. September 2018 Medi-Cal Provider Seminar

The September Medi-Cal provider seminar is scheduled for September 18 – 19, 2018, 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 the DHCS Fiscal Intermediary (FI) 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 September 4, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 4, 2018, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 web 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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4. Reminder: Do Not Staple Paper Claim Forms

Providers are reminded to not staple paper claim forms as staples delay claims processing. For more general reminders about paper claim submission, providers are encouraged to check the Billing Tips: Paper Claims page of the Medi-Cal website.

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5. A New Way to Subscribe – Contact Medi-Cal Subscription Service Representatives

Medi-Cal is committed to keeping you up-to-date on the latest Medi-Cal news and policy updates.

The Medi-Cal Subscription Service (MCSS) is a free service that provides subscribers with personalized email notifications for urgent, high-impact announcements and monthly news/policy updates as they post to the Medi-Cal website.

Providers can now contact MCSS representatives directly at MCSSCalifornia@conduent.com to subscribe and for assistance with managing subscriptions. Subscribing is simple and free!

If you have not yet subscribed to MCSS, Medi-Cal encourages you to utilize one of the following two methods to subscribe.

To subscribe by email:
  1. Download the linked MCSS Subscriber Form

  2. Enter your name, email address, ZIP code and subscriber type in the appropriate fields

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Attach your completed form to an email and send to MCSSCalifornia@conduent.com
To subscribe online:
  1. Go to the MCSS Subscriber Form page on the Medi-Cal website

  2. Enter your email address and ZIP code, and select a subscriber type from the drop-down menu

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Click “Subscribe Now” at the bottom of the page

After the form has been received, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, visit the MCSS Help page.

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

MCSS Logo

The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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