Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

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.


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.