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Providers Should Begin Including ICD Indicator on 25-1 Paper Claim Forms

September 10, 2014

Payment Request for Long Term Care (25-1) paper claims mailed on or after September 15, 2014, should include the ICD indicator “9” when they include a diagnosis code in the Primary DX Code field (Boxes 16, 35, 73, 92 or 111). This is in preparation for the ICD indicator requirement for claims received on or after September 22, 2014.

No indicator is required if the claim is submitted without a diagnosis code. Claims with a diagnosis code received on or after September 22, 2014, that do not include the ICD indicator “9” will be returned via the Resubmission Turnaround Document (Form 65-1).

For more information about the ICD indicator requirement, please see the Claim Form Updates page of the Medi-Cal website.