Effective September 22, 2003, Medi-Cal billing changed significantly due to the Health Insurance Portability and Accountability Act (HIPAA). Below are the most common questions providers ask about HIPAA when they call the HIPAA Help Desk at 1-800-541-5555 (select Option 4).

1. Will Medi-Cal continue to accept paper claims after October 16, 2003?
   Providers who submit paper claims may continue to do so beyond the final compliance date for the Transactions and Code Sets Final Rule (October 16, 2003). However, regardless of the media used to submit claims (hard copy, electronic, etc.), the new national administrative . and limited service and procedure codes are required on all claims with dates of service on or after September 22, 2003. To review codes that are effective September 22, 2003, refer to the appropriate Part 2 manual or Medi-Cal Code Correlation tables included in previously released Medi-Cal Updates. You can also review codes on the Medi-Cal Web site's HIPAA Code Correlations page.



2. Will Medi-Cal continue to accept non-standard and proprietary electronic claim formats after September 22, 2003?
   Yes. Submitting claims using the new 837 4010A1 electronic format is not mandatory at this time. Providers who submit claims using Computer Media Claims (CMC) proprietary formats may continue to do so. However, there will be a phase-out period for non-standard and proprietary electronic claim formats in the future. Providers will be notified of the time frame for the phase-out period in a future Medi-Cal Update and on this Web site.



3. Do current CMC submitters need to complete a new electronic agreement as a result of HIPAA?
   Yes. A new Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHS 6153 form) is required for current CMC submitters so Medi-Cal can update their submitter profiles.
   
   To learn more about the enrollment, testing and activation process that must occur before submitting CMC claims, refer to the July Medi-Cal Update or to the CMC sections of the Part 1 manual.



4. How can software vendors arrange to transmit test files to Medi-Cal?
   Software vendors who do not currently submit CMC claims on behalf of providers must first obtain a test submitter ID number by completing a Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHS 6153 form). Once a submitter ID number is issued, the vendor is able to transmit test files to the CMC unit.
   
   Software vendors who have an active submitter ID number and currently submit CMC claims on behalf of providers must complete a new DHS 6153 form so Medi-Cal can update their submitter profiles. On the agreement, vendors must request that the 837 4010A1 transaction be added to their submitter profiles.
   
   To learn more about the enrollment, testing and activation process that must occur before submitting CMC claims, refer to the July Medi-Cal Update or to the CMC sections of the Part 1 manual.



5. Where can providers find information about HIPAA code changes?
   Visit the HIPAA Code Correlations page on this Web site. Note that ongoing HIPAA code changes will be included in future Medi-Cal Updates. If you are unable to find specific current codes on this Web site, this means the codes are not changing at this time and are scheduled to be implemented in a future phase of HIPAA.



6. Can providers enroll for the ANSI ASC X12N 835 transaction (the Electronic Remittance Advice Details or “835” transaction) and continue using Automated Remittance Data Services (ARDS) to receive Remittance Advice Details (RAD) information?
   Yes. Medi-Cal will continue to support ARDS. Providers can enroll for the 835 transaction and continue to receive RAD information using ARDS. Note that enrolling for the 835 transaction does not automatically prevent providers from receiving paper RADs; providers must specifically request not to receive paper RADs. To enroll for the 835 transaction, providers must complete an Electronic Health Care Claim Payment/Advice Receiver Agreement (DHS 6246 form). Refer to the Remittance Advice Details (RAD): Electronic section in the Part 1 manual for more information.



7. When Pharmacy providers enroll to receive the 835 transaction, do they need to submit a separate Electronic Health Care Claim Payment/Advice Receiver Agreement (DHS 6246 form) for each pharmacy location?
   Yes. Pharmacy providers must submit a separate DHS 6246 form for each pharmacy location. The form allows individual providers (or locations) to designate up to two (2) receivers to receive their RAD information. Refer to the Remittance Advice Details (RAD): Electronic section in the Part 1 manual for more information.



8. Where can providers who bill using the UB-92 Claim Form find the frequency code for the type of bill?
   The frequency code is the third character of the type of bill code. Providers can obtain type of bill codes from the UB-92 National Uniform Billing Data Element Specifications manual or the National Uniform Billing Committee (NUBC) Web site.



9. Where can Pharmacy providers find technical specifications for the National Council for Prescription Drug Programs (NCPDP) Version 5.1 format?
   Visit the HIPAA ASC X12N Companion Guides and NCPDP Technical Specifications page of this Web site.



10. Is an electronic version of the HCFA 1500 claim form available to providers?
    Yes. Allied Health, Medical Services (General Medicine and Obstetrics) and Pharmacy providers can submit claims for medical services and supplies using the 837 Professional Claim transaction, which is available on this Web site through the Transaction Services page. The 837 Professional Claim transaction is a fast, paper-free alternative to the HCFA 1500 paper claim form. Allied Health, Medical Services and Pharmacy providers are encouraged to submit claims using the 837 Professional Claim transaction.