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PM 160 Information Only Discontinued for FQHCs, RHCs and IHS-MOA Clinics

August 5, 2019

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics bill Early and Periodic Screening, Diagnostic and Treatment/Child Health and Disability Prevention (EPSDT/CHDP) services using the UB-04 claim. Effective September 1, 2019, FQHCs, RHCs and IHS-MOA clinics will no longer submit the Confidential Screening/Billing Report Information Only (PM 160 Information Only) with claims to fulfill reporting purposes. Instead, these providers will fulfill reporting requirements by including informational lines on their claims. Required reporting data will be extrapolated from the informational lines.

Providers submitting paper claims can refer to a sample UB-04 claim populated with informational lines in the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Examples provider manual section. Instructions for submitting informational lines on electronic claims is available in the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual, “Special Billing Instructions: Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Services-Memorandum of Agreement” section.

Additionally, beginning September 1, 2019, providers should no longer order PM 160 Information Only forms.

Providers are encouraged to watch for CHDP updates in the NewsFlash area on the Medi-Cal website and subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to CHDP by completing the MCSS Subscriber Form.

Providers with questions or concerns may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Email Address for Questions/Concerns
Providers may submit questions or concerns about the preceding to CHDPTransition@conduent.com.

Updated manual pages will be released in future CHDP Update and Medi-Cal Update bulletins.