No. A TAR is not necessary unless you are using prosthetic or orthotic codes. If the TAR requires prosthetic or orthotic codes, call your local field office and use the standard procedure for requesting a TAR.

Yes. Medi-Cal accepts and adjudicates outpatient, paper crossover claims using national code set values rather than Medi-Cal codes for any code sets being converted. Those claims with dates of service before September 22, 2003 must be billed using local codes. Those with dates of service on or after September 22, 2003 must be billed using the new national code set values. Code sets that have been converted are listed on the HIPAA Code Correlations page or in the appropriate ection in the provider manual:

• Allied Health/Medical Services/Pharmacy: HCFA 1500 Completion (hcfa comp)
• Inpatient: UB-92 Completion: Inpatient Services (ub comp ip)
• Long Term Care: Payment Request for Long Term Care (25-1) Completion (pay ltc comp)
• Out patient: UB-92 Completion: Outpatient Services (ub comp op)
• Vision Care: Payment Request for Vision Care and Appliances (45-1) Completion (pay vc comp)

Yes. The field for the delay reason code on the UB-92 Claim Form is the Delay Reason field (Box 31). Prior to HIPAA implementation, Medi-Cal did not use this field and providers could enter any information into it. Because of HIPAA, however, Box 31 is reserved only for the delay reason code. Entering other information in this field could delay claim processing.

Effective for dates of service on or after September 22, 2003, submitters of paper claims and submitters of the new 837 4010A1 format must use the new HIPAA-compliant administrative code sets, and a limited number of service and procedure code sets. Refer to the HIPAA Code Correlations page on the Medi-Cal Web site for more information. Providers who continue to submit claims electronically using the current non-standard and proprietary EDI format should use the current Place of Service codes and delay reason codes due to the limited field length.

Yes. For claims that do not cross over electronically, Medi-Cal does plan to accept Medicare/Medi-Cal (coordination of benefits) claims electronically from providers in a phased approach. The specific timeline has not been confirmed. Testing and implementation dates will be published in Medi-Cal Updates and on the HIPAA News Web page.

Yes, Medi-Cal will accept and process electronic and hardcopy claims with local codes for dates of service prior to September 22, 2003.

Inpatient stay split billing is not necessary. Since the admit date was before September 22, the entire stay in this example should be billed with current Medi-Cal codes. Inpatient claims will be adjudicated based on the "From Statement Covered Period Date" (or the equivalent electronic field) to determine which code value to use. Claims with a "From Statement Covered Period Date" prior to September 22, 2003 must bill the appropriate local or national codes. Claims with a "From Statement Covered Period Date" on or after September 22, 2003 must bill the appropriate national codes. This rule applies regardless of the length of the inpatient stay. Inpatient claims using revenues codes inappropriate for the date of service will be returned to providers through the Resubmission Turnaround Document (RTD) process.

The Health Insurance Portability and Accountability Act (HIPAA) established standard code sets for transactions. These standard code sets include, but are not limited to:

• National Drug Codes (NDCs)
• International Classification of Diseases (ICD-9-CM) diagnoses and inpatient hospital procedures
• Health Care Procedure Coding System (HCPCS)
• Inpatient revenue codes
• Place of Service codes
• Patient status codes
• Delay reason codes
• Healthcare Common Procedure Coding System (HCPCS) Levels I and II

To correlate local codes to national codes, Medi-Cal has worked with the provider community and researched industry practices. All state-only and proprietary codes are disalowed for use under the HIPAA regulations. Medi-Cal is using a phased implementation approach for code transition. Specific information has been detailed in the Medi-Cal Update since April 2003.

No. Medi-Cal does not want any punctuations or symbols for ICD-9-CM V3 procedure code values. This is in accordance with current billing guidelines and applies to hardcopy and electronic claims.

Medi-Cal is not converting from the proprietary 25-1 Long Term Care form at this time. There is a plan to transition to the UB-92 at a later date in conjunction with the code set changes necessary for this provider type (patient status codes and accommodation/revenue codes).

Yes. Medi-Cal will accept and adjudicate outpatient paper crossover claims using national code set values rather than Medi-Cal codes for any code sets being converted. For a listing of code sets to be converted effective October 2003, go to the HIPAA ASC X12N Technical SpecificationsWeb page. In addition, Medi-Cal will eventually accept and adjudicate Medicare/Medi-Cal outpatient claims directly from Medicare Intermediaries. This will reduce the need for providers to bill these claims on paper. Implementation plans and timelines will be posted on the HIPAA Implementation Schedule Web page.