If I continue to submit paper claims, will I still be able to use the ASC X12N 835 transaction to see if the claim was paid or denied?

Yes. Status of the provider’s claim will appear on the ASC X12N 835 transaction (Electronic Remittance Advice Details, or RAD) for claims submitted in paper or electronic format.

Will CHDP or CalOptima claims data appear on the ASC X12N 835 transaction?

No. There will be no 835 transaction for CHDP or CalOptima claims.

Why don’t my claims appear in the ASC X12N 835 transaction?

Only claims paid or denied on or after September 22, 2003 appear on the 835 transaction. Also, a suspended claim will not appear on the 835 transaction.

How often is the ASC X12N 835 transaction updated, and how long will it be available for online viewing?

835 transactions are updated every Wednesday and will be retained for six weeks. For 835 transaction data older than six weeks, refer to the Medi-Cal provider manuals for instructions on how to order a hard copy RAD.

How does a CMC (Computer Media Claims) submitter log on to the IBBS to retrieve ASC X12N 835 transactions from multiple providers?

Medi-Cal’s Internet Bulletin Board System (IBBS) is accessed through this Web site. Select Transaction Services from the home page and you will be prompted for your CMC submitter number and password at the login center page. While access frequency is not limited, CMC submitters will only need to log on to the IBBS with their submitter ID and password once to access and retrieve the ASC X12N 835 transactions for all providers for which they have been designated as the authorized receiver. The transactions will be zipped into a single file for easy receiver download.

Is a new PIN or a CMC Agreement required for the ASC X12N 835 transaction (Electronic Remittance Advice Detail)?

Authorizing providers are required to complete and sign the new Electronic Health Care Claim Payment/Advice Receiver Agreement form before they can receive ASC X12N 835 transactions from Medi-Cal or designate a receiver(s) for those transactions. Receiver(s) are required to have a valid Medi-Cal Provider Number and seven-digit PIN along with a valid Medi-Cal Point of Service (POS) Network/Internet Agreement or a Computer Media Claims (CMC) Submitter Number (three digits) and password.

When will Medi-Cal begin testing the X12N 835 version 4010A1 transaction standard, and what media type will be used?

Medi-Cal will begin limited beta testing with a predetermined, select group of providers, submitters, vendors and clearinghouses for the ASC X12N 835 and ASC X12N 837 standard transactions in mid to late summer. The X12N 835 version 4010A1 standard transaction will be available as a zipped, downloadable file from a single media source, the Internet Bulletin Board System (IBBS).

Because one X12N 835 version 4010A1 equals one check, and Medi-Cal issues one check for each provider, will a provider be inundated with hundreds of X12N 835s or will Medi-Cal change its policy of one check per provider?

Medi-Cal plans to publish its 835 enrollment requirements later this spring or early summer. The 835 transaction receiver or receivers will be required to be an authorized Computer Media Claims (CMC) submitter or have a valid Medi-Cal Point of Service (POS) Network/Internet Agreement on file. Authorizing providers will be required to complete and sign an Electronic Health Care Claim Payment/Advice Receiver Agreement before they can receive 835 transactions from Medi-Cal or designate a receiver or receivers for 835 transactions. On the receiver agreement, the authorizing provider may designate up to two receivers (CMC submitter or Internet-enabled) for 835 transactions (the authorizing provider may designate itself as a receiver). If a provider with multiple sites chooses the same receiver, they will receive one downloadable zip file with all of their sites’ warrant information (835 transactions) included.

An 835 transaction will equate to one check. This is consistent with Medi-Cal’s current disbursement policy.

For example:
Provider A completes the receiver agreement form and designates Receiver A and Receiver B to receive 835 transactions.

Provider B (same parent entity, different location) completes the receiver agreement form and designates Receiver A to receive 835 transactions.

Receiver A will receive all warrants (835 transactions) for Providers A and B in the same downloadable zip file.

Receiver B will receive only Provider A's warrants (835 transactions) in a downloadable zip file.

Medi-Cal will continue to provide separate warrants for each provider per Fund (Medi-Cal, California Children's Services/Genetically Handicapped Persons Program, etc.). Therefore, each warrant in a downloadable file is identified within a single Functional Group Envelope.