HIPAA: Upcoming Vision Care Changes in July 2006
February 2, 2006As part of the continuing effort to comply with the federally mandated Health Insurance Portability and Accountability Act (HIPAA), the following vision changes will become effective for dates of services on or after July 1, 2006:
- Vision Electronic Claim Submitters:
- Medi-Cal will discontinue acceptance of non-HIPAA standard electronic formats for vision claim transactions. REGARDLESS of Date of Service, as of July 1, 2006, the Department of Health Care Services (DHCS) will no longer accept the Vision Computer Media Claim (CMC) proprietary format. Electronic claims must be billed using the HIPAA-compliant ASC X12N 837 Professional version 4010A1 format or Internet Professional Claims Submission System (IPCS).
- ASC X12N 837 v.4010A1 Vision Companion Guide will be replaced with the ASC X12N 837 v.4010A1 Medical Companion Guide for dates of service on or after July 1, 2006. The companion guides can be found in the HIPAA Update area of the Medi-Cal Web site.
- Vision Paper Claim Submitters:
- Paper claims must be billed on the HCFA 1500 claim form. Medi-Cal’s proprietary Payment Request for Vision Care and Appliances (45-1) claim form will no longer be accepted.
- New Vision TAR Procedures:
- As a result of the discontinuance of the Payment Request for Vision Care and Appliances (45-1) claim form previously used to request prior authorization for eye appliances, a new Treatment Authorization Request (TAR) form (50-3) has been created for this purpose. Watch for future Medi-Cal Updates and announcements on the Medi-Cal Web site for details about this new form and authorization process.
- Vision Procedural changes:
- Conversion of Medi-Cal Healthcare Common Procedure Coding System (HCPCS) Level III interim codes to national HCPCS Level II and Physician’s Current Procedural Terminology (CPT) Level I codes.
- Elimination of vision qualifying codes and the use of national modifiers.
Medi-Cal Public Comment Forum
The Medi-Cal Public Comment Forum is available through February
28, 2006. To make comments regarding the vision code
conversion, visit the
Medi-Cal Comment Forum page. Providers may then view the
proposed code conversions and e-mail their comments to Medi-Cal.
Instructor-Led Seminars for Upcoming Vision Changes
Providers can access the upcoming dates and locations for Vision
Seminars by visiting the
Medi-Cal Instructor-Led Seminars page.
Self-Service HIPAA Transaction Utility Tool
A self-service environment HIPAA Transaction Utility Tool is
available for submitters. The utility tool offers transaction
validation (inclusive of Companion Guide-level editing),
troubleshooting and reporting features that enhance, but do not
replace, Medi-Cal’s current testing and media activation
requirements. Vision electronic claim submitters have been
notified via letter of utility availability, with instructions
on how to use it.
Electronic Attachments
New attachment submission options to expedite claims processing
are available to providers or submitters. Providers now have the
ability to submit fax and electronic attachments with 837
v.4010A1 electronic claim submissions. This new functionality
allows providers to submit electronic claims and fax their
attachments, or send the attachments electronically through an
approved third-party vendor. An approved list of third-party
vendors available for electronic attachment submissions will be
announced in a future Medi-Cal Update.
In addition to faxing them, providers may also send hard copy attachments by mail. For details on how to send attachments, along with the address to mail the attachments to, please refer to the Billing Instructions section of the 837 Version 4010A1Health Care Claim Companion Guide on the Medi-Cal Web site.
The 837
Version 4010A1 Electronic Claims with Attachments Now Available
article published in the January 2006
Medi-Cal Update is also available for reference.
Additional Resources
For more information, in-state providers may call the Telephone
Service Center (TSC) at 1-800-541-5555, 8 a.m. to 5 p.m., Monday
through Friday. Border providers, software vendors and
out-of-state billers who bill for in-state providers should call
(916) 636-1200.
Note:
If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.