HIPAA: Vision Care Electronic Claim Form Changes Effective July 1, 2006
May 3, 2006Conversion to HIPAA-Compliant Electronic Claim Transactions
Effective July 1, 2006, the Vision CMC proprietary claims
transaction format will no longer be accepted for vision services,
regardless of the date services were performed.
When converting to the ASC X12N 837 v.4010A1 transaction, the Vision Data Specifications should be used for claims with dates of service prior to July 1, 2006. For dates of service on or after July 1, 2006, the Medical Data Specifications (part of the 837 v.4010A1 Health Care Claim Companion Guide) have been updated to include the required segments for vision claims.
The companion guides are available on the ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications page of the Medi-Cal Web site.
Electronic Claim Submission Using the Internet
Available for claims with dates of service on or after July 1,
2006, the HIPAA-compliant 837 Internet Professional Claim
Submission (IPCS) Online Claim Form will be updated to give
vision care providers an alternate method of submitting
electronic claims in real-time through the Medi-Cal Web site.
The online claim form will be updated to include new fields
necessary for billing vision services. The
Internet Professional Claim Submission (IPCS) User Guide
will be updated to reflect these changes.
The IPCS system allows users to submit single vision service claims in real-time. The IPCS system does not perform online adjudication nor does it accept crossover claims. Claims submitted successfully receive a Claim Control Number (CCN) on the host response screen. If the IPCS system detects errors, the user will receive a “CLAIM REJECTED” message on the host response screen, and the claim can be edited to correct these errors before resubmitting. Submitted claims enter the daily batch cycle of the Medi-Cal claims processing system.
The IPCS system allows faster, more efficient, data exchange between providers and the California Department of Health Services (DHCS).
To use the IPCS system, providers must have both of the following:
-
A Medi-Cal Point of Service (POS) Network/Internet Agreement form on file with DHCS for each provider number that is used to bill. If providers currently have valid forms on file, no additional updates are needed. Providers can download the form from the Medi-Cal Web site. Providers should print the form, complete, sign and return it to Medi-Cal at the address shown on the bottom of the form.
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A valid Computer Media Claims (CMC) submitter ID and password. To obtain or update your ID and password, complete the Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153). Check the “Internet” box in the Real Time Submission Type section, check Medical/Allied Health (05) and enter 4010X098 where indicated in the ANSI X12 837 Version section.
Note:
Submitters with a current, valid CMC submitter ID must still submit the Medi-Cal Telecommunications Provider and Biller Application/Agreement to add the IPCS application to their list of available Internet options.
As of July 1, 2006, only professional medical and vision claims can be submitted using IPCS; Institutional claims cannot be submitted.
Additional Resources
Recent Medi-Cal Updates have provided detailed information
about the upcoming changes to the Vision Care Program.
Providers are encouraged to review the bulletins listed below on the
Vision Care (VC) Bulletins page of the Medi-Cal Web site.
- April 2006: "New Vision Care Treatment Authorization Request (TAR) Process Effective July 1, 2006" (VC 338)
- March 2006: "Convert Early to HIPAA-Compliant Electronic Claim Transactions" (VC 337)
- February 2006: "Upcoming Vision Care Changes in July 2006" (VC 336)
- January 2006: "Conversion of Vision Care Interim Billing Codes and Modifiers and Notice of Public Comment Period" (VC 335)
For more information, call the Telephone Service Center (TSC) at 1-800-541-5555, from 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. To learn more about other vision care-related HIPAA changes, refer to the HIPAA News area of the Medi-Cal Web site.
Note:
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