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CHDP Code Conversion Readiness Checklist

July 26, 2017

The following checklist has been prepared in anticipation of implementation of the Bright Futures Periodicity Schedule and transition of Child Health and Disability Prevention (CHDP) claims processing to the California Medicaid Management Information System (CA-MMIS).

The goal of the CHDP transition and code conversion is to replace two-digit local CHDP codes with HIPAA-compliant CPT-4 procedure codes. This transition impacts qualified Medi-Cal providers enrolled in the CHDP program who currently bill on the CHDP proprietary claim form, Confidential Screening and Billing Report (PM 160). CHDP Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) services must be billed on a CMS-1500, UB-04 or electronic equivalent as follows:

  • Laboratory-only services billed by clinical laboratory providers: Claims with dates of service on or after February 1, 2017
  • Well-child health assessments/vaccines and laboratory in combination with other services:  Claims with dates of service on or after July 1, 2017

The PM 160 claim form will continue in use for laboratory-only services claims for dates of service prior to February 1, 2017 and all other CHDP services for dates of service prior to July 1, 2017. Providers should note that national codes cannot be submitted on the PM 160.

The following readiness checklist is intended to be a general guide, not a comprehensive project plan. Medi-Cal recommends that providers use this checklist as a guideline to prepare themselves for the code conversion implementation.

Prepare for the CHDP Code Conversion Implementation: Plan, Communicate and Review

Requires Immediate Attention

Recommended Start Date: May 2017
  • Review CHDP resources from Medi-Cal, CMS, vendors/billing contractors and other resources.
  • Notify your staff of the future code conversion implementation.
  • Assemble a code conversion project team to handle tasks and oversee the implementation. Be sure to include individuals from different business units affected by the code conversion.
    • Assign individual tasks to different members of the code conversion team, such as the completion of system changes and testing, provision of training and education, and modification or development of policies/procedures and reports. At group meetings, assess progress of the implementation.
  • Assess the effects of the code conversion on your organization.
    • Assess the effect on all business units.
    • Identify current learning/skill gaps for coding/billing staff.
  • Create a plan of action to address the code conversion.
    • Identify goals and develop a strategy to undertake the code conversion.
    • Keep concise and consistent messages as part of a communication strategy to educate stakeholders (upper management, IT staff and transitory staff).
  • Business Partner Preparedness: Assess the timeframe it will take other billing service contractors to prepare for the code conversion. Assess contractor preparedness by using a timeline for upgrading the system. Providers are strongly encouraged to routinely check the monthly Medi-Cal Provider Bulletins as well as the Medi-Cal Learning Portal Training Calendar for announcements of upcoming training and webinars developed for providers.
  • Review the following code conversion crosswalk for a full description of the new HIPAA-compliant billing code sets.
CHDP Code Conversion Implementation and Testing

Recommended Start Date: May 2017
  • Conduct high-level training with clinicians and coders.
    • Offer designated coders and other personnel comprehensive instruction for training, mapping and auditing.
  • Begin internal testing and validate the system changes.
  • Begin external testing with vendors and other contractors.
  • Start reviewing coder and clinician preparation and start detailed coding.
  • Get vendors to complete implementation to production-ready systems.
  • Develop a back-up plan for continuing operation if a critical system fails or has a problem during code conversion implementation.
  • Create a communication plan for post code conversion implementation.
Preparing for Go-Live

Recommended Start Date: June 2017
  • Confirm with system contractor(s) that upgrades/enhancements in the contractor system have been completed.
  • Finalize all internal system upgrades and testing.
  • Make any adjustments to results of testing responses and perform regression testing.
  • Revisit and conduct a test of the back-up plan to remain operational in case the implementation of the CHDP code conversion poses any problems.
  • Finalize external testing with outside contractors.
  • Coding staff should complete their comprehensive code conversion training prior to the go-live date. It is recommended that training begin before implementation.
  • Resolve any problems/issues that appeared during testing that could have been overlooked.
  • GO-LIVE: Implement the code conversion by July 1, 2017.
Completing CHDP Code Conversion Implementation and Post-Compliancy

(Must be completed by July 1, 2017)
  • Complete the code conversion implementation full compliance: July 1, 2017. Codes are required for dates of service on or after July 1, 2017.
  • Monitor errors if they occur.
  • Continue any coding staff training if learning gaps are discovered.
  • Refer to the Frequently Asked Questions as needed.