June 2005

In accordance with efforts to comply with the federally mandated Health Insurance Portability and Accountability Act (HIPAA), Medi-Cal has established a plan to discontinue acceptance of proprietary and non-HIPAA standard electronic formats for electronic claim transactions. The first provider community to be affected is the Inpatient provider community.

Beginning December 1, 2005, proprietary and non-HIPAA standard electronic claim formats submitted by Inpatient providers will no longer be accepted.

Medi-Cal now offers Computer Media Claims (CMC) filing using the ASC X12N 837 4010A1 transaction format. Acceptable media submission types are dial-up, tape or Internet. CMC and paper claims must meet the same billing requirements according to Medi-Cal policy.

Information for 837 Transaction Applicants
The HIPAA Update and HIPAA News pages include links to a number of Web pages with important information for 837 transaction submitters and applicants, including technical specifications, implementation instructions, user guides, frequently asked questions (FAQs) and biller updates.

Application/Agreement Form
Providers may submit 837 transactions directly or employ a billing service to prepare and submit their 837 transactions. To become an authorized 837 transactions submitter, providers and billing services must first complete, sign and mail an application/agreement. The form is also found after the CMC Enrollment Procedures section in the Part 1 manual.

Providers may call the Telephone Service Center (TSC) at 1-800-541-5555 for more information.

Cut-off dates for non-HIPAA standard claim formats for all other provider communities will be announced in upcoming Medi-Cal Updates.