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HIPAA 5010 Medi-Cal Companion Guide Update

June 6, 2014

The HIPAA 5010 Medi-Cal Companion Guide has been recently updated and is located under the Technical Specifications menu on the HIPAA: 5010/NCPDP D.O & 1.2 page of the Medi-Cal website.

Providers should note the following when submitting 5010 transactions:

  • Providers submitting 837I transactions via Computer Media Claims (CMC) can submit up to 999 claim lines, on or after July 21, 2014. This applies only to straight CMC claims and does not include Crossover Part B Claims (COBC) or straight crossovers.
  • Providers submitting 837P transactions via CMC can submit up to 50 claim lines, on or after July 21, 2014. This applies only to straight CMC claims and does not include COBC or straight crossovers.
  • When billing CMC crossover claims, providers shall not exceed the maximum total line limits: (inpatient crossovers – 22, outpatient crossovers – 15, medical crossovers –15).
  • When a provider submits more than 22 claim lines for an inpatient claim, the provider must abide by the following billing instructions for CMC:
    • When submitting inpatient claims, the provider must bill all accommodation codes before billing ancillary codes.
    • When submitting inpatient claims, the provider must include accommodation codes 112, 122, 132, 152, and 172 or 171 in the first 22 claim lines.
    • If the provider intends to resubmit a claim, the provider must first void the entire claim and then resubmit it.
  • When an inpatient claim with more than 22 lines is submitted, the California Medicaid Management Information System (CA-MMIS) will split the claim into several pages, each containing 22 claim lines. The provider will receive a separate Remittance Advice Details (RAD) for each page.
  • CA-MMIS will identify each inpatient claim as being part of a split claim by utilizing the MIA segment with Remittance Advice Remark Code MA15 (Your claim has been separated to expedite handling. Providers will receive a separate notice for the other services reported) on each of the adjudicated (split) claims.