Computer Media Claims (CMC) Submission
Regardless of the date of service, effective July 1, 2006, the Department of Health Care Services (DHCS) discontinued the Vision CMC proprietary claims transaction format. For dates of service prior to July 1, 2006, the ASC X12N 837 v.4010A1 Professional Vision Data Specifications, also known as Vision claim type 07, must be used. For dates of service on or after July 1, 2006, the ASC X12N 837 v. 4010A1 Professional Medical Data Specifications, also known as Medical (or Physician) claim type 05, must be used.

The companion guides are available on the ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications page.

CMC Rejected Files and Denied Claims
An electronic file that does not pass the CMC editing process is rejected. A rejected file does not enter the claims adjudication system, and a Remittance Advice Details (RAD) entry is not generated. The submitter can view the status of an electronic file or volser by logging in to Transaction Services and clicking the “CMC Status” link. An electronic file or volser rejection is displayed as a partial release or a deletion, depending on the severity or type of error.

When claims are denied, the electronic file passed the CMC editing process, and the volser status is displayed as a release or partial release. The file entered the claims adjudication system, but failed Medi-Cal policy edits and/or audits. A RAD entry is generated for denied claims.

Common Submission Errors

The table below lists the most common claim submission errors that cause rejections of electronic files or denial of claims with the correlating error codes and messages:

Code	Message	Claim Submission Error
CMC error 058	Media type/claim type not valid for this submitter.	Vision CMC 07 (proprietary format) usage on or after 7/1/06
RAD message 0137	Billing cannot precede date of service or date of appliance delivery.	Vision claims submitted on the incorrect paper claim form
RAD message 0139 (vision 837 claims)	Procedure/service is invalid for claim type on date of service.	ASC X12N 837P vision format claims for dates of service on or after 7/1/06
RAD message 0139 (medical 837 claims)	Procedure/service is invalid for claim type on date of service.	ASC X12N 837P medical format claims for dates of service prior to 7/1/06
RAD message 0139 (vision claims via IPCS)	Procedure/service is invalid for claim type on date of service.	Vision claims submitted via Internet Professional Claim Submission (IPCS), for dates of service prior to 7/1/06
RAD message 0145	This procedure is not a Medi-Cal benefit on this date of service.	Vision claims submitted with incorrect procedure and/or qualifier codes for date of service billed

Paper Claims
For dates of service prior to July 1, 2006, claims must be submitted on the proprietary Payment Request for Vision Care and Appliances (45-1) claim form. For dates of service on or after July 1, 2006, claims must be submitted on the CMS 1500 (formerly HCFA 1500) form.

Internet Professional Claims Submission
The HIPAA-compliant 837 Internet Professional Claim Submission (IPCS) Online Claim Form has been updated and is available for claims with dates of service on or after July 1, 2006. The IPCS system gives vision care providers an alternate method of submitting electronic claims in real-time through the Medi-Cal Web site.

Code Changes for Dates of Service on or after July 1, 2006

• 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.
• Transition to the use of national modifiers.

Reminder: Use Medi-Cal interim and qualifying codes for claims with dates of service prior to July 1, 2006. Use national codes and modifiers for claims with dates of service on or after July 1, 2006.

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.

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.

• 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)