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FQHC/RHC/IHS-MOA Code Conversion Technical Publications & Support

September 15, 2017

Health Insurance Portability and Accountability Act (HIPAA) mandated changes to billing requirements for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics. These changes include the use of Healthcare Common Procedure Coding System (HCPCS) Level I and Level II national codes.

Effective for dates of service on or after October 1, 2017, claims submitted by FQHC/RHC/IHS-MOA providers without HIPAA-compliant billing code sets will be denied. Timeliness will not be overridden.

The Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual is updated on an ongoing basis to reflect HIPAA 5010 and NCPDP D.0/1.2 formats. The updated sections are posted under the “5010 CMC Billing and Technical Manual” heading as they are completed. “Special Billing Instructions: FQHC/RHC/IHS-MOA” will be added to the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual.

THERE IS NO CHANGE TO THE 837I TRANSACTION.

Submitters are encouraged to visit the Testing and Activation Procedures section of the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual required by CMC to ensure accurate file format, completeness and validity.

A new test must be submitted when software is upgraded or the submission method changes. Submitters may test status for HIPAA-related compliant claims transactions through the Medi-Cal test site.

CMC evaluates the test file and determines if the following requirements have been met:

  • All format types
  • Telecommunications equipment is technically compatible with the DHCS Fiscal Intermediary (FI) system.
  • The claim data can be read by the claims processing system.
  • Records and mandatory fields required for CMC are present and contain valid information (for example, provider number[s], submitter number, control records, claim records).

The CMC Help Desk can be accessed by calling the Telephone Service Center (TSC) at 1-800-541-5555 and select the option “Point of Service (POS), Internet, Laboratory Services Reservation System (LSRS) and CMC inquiries.”

For additional information regarding the FQHC/RHC/IHS-MOA Code Conversion, providers may:

  • Visit the HIPAA: Code Conversions web page of the Medi-Cal website for updated resources such as:
    • Provider articles
    • FQHC/RHC Code Conversion crosswalk
    • IHS-MOA code conversion crosswalk
    • Newly updated Frequently Asked Questions (FAQs)
    • Newly updated Provider Readiness Checklist
  • Routinely check Medi-Cal Updates.
  • Routinely check the Medi-Cal Learning Portal Training Calendar for announcements of upcoming training and webinars developed specifically for FQHC/RHC/IHS-MOA providers
  • Request a monthly email notification for newly published Medi-Cal Updates by completing the MCSS Subscriber Form.
  • Request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday. Border Providers and Out-of-State Billers billing for In-State Providers call 1-916-636-1200. Providers calling from outside of California call the Out-of-State Provider Unit at 1-916-636-1960 from 8 a.m. to 12 p.m. Monday through Friday, except holidays.
  • Submit additional questions via email to CAMMISCodeConversion@conduent.com.