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CHDP Phase 3 HIPAA Code Conversion: School-Based Services Crosswalk

July 25, 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.

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.