HIPAA: CHDP Exception to December 1, 2006 Electronic Claim Form Transition
Updated May 18, 2006All Medi-Cal providers submitting electronic claims must submit using HIPAA-compliant transactions beginning December 1, 2006, except for Child Health and Disability Prevention (CHDP) providers (claim type 11). CHDP claims will be transitioned to a HIPAA-standard claim format at a later date. It should also be noted that Vision electronic submitters will be transitioned to a HIPAA-standard claim format on July 1, 2006 and Medi-Cal will no longer accept the proprietary format for this group of providers.
Medi-Cal is currently accepting both HIPAA compliant and non-HIPAA compliant electronic claims transactions as part of a contingency plan to assist submitters in transitioning to full compliance. However, due to required changes in support of the NPI, Medi-Cal must discontinue proprietary and non-HIPAA standard electronic claim transactions.
Medi-Cal offers the HIPAA-compliant ASC X12N 837 v.4010A1 transaction for Computer Media Claims (CMC). Acceptable submission types are dial-up, tape or Internet. CMC must still meet current Medi-Cal policy and billing requirements.
IPCS for Professional Claim Submissions
Another option for Professional claim submitters is the Internet
Professional Claim Submission (IPCS), a free-of-charge direct data
entry system accessible via the
Transaction Services page on the Medi-Cal Web site. IPCS is
used to submit single claims in the HIPAA-compliant ASC X12N 837
v.4010A1 Professional format.
To use IPCS, you must have a Medi-Cal Point of Service (POS) Network/Internet Agreement and a Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) on file with Medi-Cal. There is no testing required for IPCS once both forms are submitted to Medi-Cal.
Self-Service HIPAA Transaction Utility Tool
To support the transition, Medi-Cal has implemented a Web-based,
self-service transaction validation environment – the HIPAA
Transaction Utility Tool. The utility tool is offered at no cost and
offers everything providers need to exchange Electronic Data
Interchange (EDI) files with Medi-Cal.
The utility tool allows providers to test transactions prior to actually sending them to Medi-Cal. The tool also contains documentation such as EDI specifications (companion guides) in a format that can be viewed online or easily downloaded. The utility tool validates transactions based on the companion guide requirements and offers troubleshooting and reporting features that enhance Medi-Cal's current testing and media activation requirements.
Providers can access the HIPAA Transaction Utility Tool from the Medi-Cal Web site sysdev Transaction Services page. We strongly encourage you to take advantage of this service.
- Enter your current Medi-Cal submitter ID and password. (Your submitter ID must have “CMCSUB” as a prefix and the password is the same password used for CMC dial-up access.) Click “Submit.”
- The “Transaction Services” menu will appear. Click the “HIPAA Transaction Utility Tool” link. A separate window will open for the application.
- When the Transaction Utility Tool application is open, click the “User Guide“ link located in the left navigation bar for step-by-step use and instructions.
- An e-mail address will be requested when adding your contact information using the HIPAA Transaction Utility Tool.
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 transaction submitter, providers and billing services
must first complete and mail an application/agreement to the CMC
Unit. The
Medi-Cal Telecommunications Provider and Biller
Application/Agreement (DHCS 6153) is available on the
Medi-Cal Forms page. More information can also be found in the
CMC Enrollment Procedures section in the Part 1 manual.
Information for 837 Transaction Submitters
The HIPAA Update
and HIPAA News
pages on the Medi-Cal Web site include links to a variety of
important information for 837 transaction submitters and applicants,
including technical specifications, implementation instructions,
companion guides, frequently asked questions (FAQs) and biller
updates.
If you have any questions, contact the Medi-Cal Telephone Service Center at 1-800-541-5555, then select Option 16 followed by Option 11 for CMC.
Note:
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