CHDP Gateway to Health Coverage

September 2018 | Bulletin 167

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1. September Updates: CHDP Phase 3 HIPAA Code Conversion for School-Based Services

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 on November 1, 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.

As a reminder, CHDP well-child health assessments and lab services conducted by school-based providers will continue to be performed in accordance with the American Academy of Pediatrics (AAP) Bright Futures periodicity schedule.

Staying Informed: CHDP School-Based Providers
The following information is being released in September 2018 to keep CHDP school-based providers informed. This information is in addition to important instructions published on the Medi-Cal website in the July 2018 article,CHDP Phase 3 HIPAA Code Conversion: School-Based Services Crosswalk.

Condition Code Required on UB-04 Claim
CHDP school-based providers also bill services for children and youth who qualify for Local Educational Agency (LEA) services. To distinguish between LEA claims and CHDP services within the Medi-Cal claims processing system, school-based providers must enter condition code “A1” (EPSDT/CHDP) in the Condition Code field (Boxes 18 – 24) on the UB-04 claim to be reimbursed for CHDP services. Claims submitted for CHDP services that do not contain the condition code will be denied.

Instructions for entering the condition code on the claim are located in the UB-04 Completion: Outpatient Services section of the Medi-Cal provider manual.

Billing CHDP and LEA Services, Same Day, Same Recipient
CHDP and LEA services must be billed on separate claim forms to allow for reimbursement.

Timeliness
Providers may continue to submit claims on the Confidential Screening/Billing Report (PM 160) up to six months after the transition date, as long as the date of service is before November 1, 2018. For dates of service after November 1, 2018, providers must submit claims for school-based CHDP services to qualified children and youth on the UB-04 claim.

After implementation, providers will have six months from the Remittance Advice Details (RAD) date to submit follow-up documentation, including:

Correction: Code Conversion Table
The full code conversion is available in the CHDP Code Conversion Table. Subsequent to its first release on July 25, 2018, this code conversion table has changed as follows: CHDP local code 23 (blood draw) is now crosswalked to CPT-4 code 99000 (handling and/or conveyance of specimen for transfer from the [physician’s] office to a laboratory), rather than CPT-4 codes 36406 and 36410. In addition, CPT-4 code 92552 (pure-tone audiometry [threshold; air only]) is removed as a benefit.

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 updates will be released in a future CHDP Update bulletin.

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2. Blood Draw and Counseling Services for CHDP Children and Youth

The following crosswalk chart is provided to illustrate the CPT-4 code billed for blood draw services rendered to Child Health and Disability Prevention (CHDP) qualified children and youth, effective for dates of service on or after May 1, 2018.

Local Code Description National Code Description Notes
23 Blood Draw for Lead Testing and Counseling 99000 Handling and/or conveyance of specimen for transfer from the [physician’s] office to a laboratory Instructions for billing CPT-4 code 99000 are included in the Pathology: Blood Collection and Handling section in the appropriate Part 2, Medi-Cal provider manual.

CHDP school-based provider exception: CPT-4 code 99000 is not reimbursable to CHDP school-based providers. They have not yet transitioned to billing CPT-4 codes on the national UB-04 claim forms. CHDP school-based providers will continue to bill local code 23 until instructed otherwise.

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

Provider Manual(s) Page(s)Updated
Child Health and Disability Prevention chdp trans (10)
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3. October 2018 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 16 – 17, 2018, at the Crown Plaza in Concord, 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 October 2, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 2, 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. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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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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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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