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CHDP Phase 3: School-Based Services Transition Coming Soon

July 10, 2018

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.

Phase 3
The transition impacts providers billing school-based services with local two-character CHDP codes on the Confidential Screening/Billing Report (PM 160) claim form. After implementation, providers will bill national codes on standard Medi-Cal claim forms, or using equivalent electronic claim transactions.

CHDP school-based services will be billed as Medi-Cal services according to Medi-Cal policies and reimbursement will be at Medi-Cal rates.

Billing Requirements
Providers will bill CHDP school-based services using:

  • HIPAA approved methods of transmission for claims for rendering CHDP school-based services to recipients
  • CPT-4 procedure codes
  • ICD-10-CM diagnosis codes, as appropriate
  • UB-04 claim forms or the ASC X12N 837I v.5010 transaction in place of the proprietary CHDP PM 160 and CHDP computer media claims (CMC) transaction

Important Transition Information
Important transition information includes the following:

  • To bill Medi-Cal for CHDP services, a provider must have an active National Provider Identifier (NPI) and be enrolled as an active Medi-Cal provider.
  • Services will be billed in conformance with the HIPAA standard transactions and code sets.
  • The transition to processing claims on the UB-04 claim form and equivalent electronic claim type will be based on a date of service cutover.
  • Providers will bill according to Medi-Cal hard copy and electronic claim submission standards.
  • Claims will need to be submitted within Medi-Cal’s six month billing limit (not the current one year submission allowance).
  • Reimbursement for services will be at the Medi-Cal rate. The Medi-Cal rate table may be accessed from the Medi-Cal website. Under the References tab, providers click “Medi-Cal Rates.”
  • Payment will be made on providers’ Medi-Cal warrant for claims processed with dates of service on or after the effective date of the transition.
  • Providers will receive a 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.
  • For services rendered with dates of service prior to the effective date of the transition, providers will continue to submit claims on the PM 160. If services are billed on the incorrect claim form for the date of service, the claim will be denied.
  • It is recommended that providers bill electronically for all its many benefits. Providers who may not be able to bill electronically and do not have a supply of national claim forms should order in advance. Delivery of forms can take some time. Providers should work with a credible vendor and purchase forms with “drop-out” ink that meets Centers for Medicare & Medicaid (CMS) standards.
  • Information submitted on UB-04 claim forms will no longer need to be reported to county CHDP offices, as was required with the PM 160 claim form.