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HIPAA ASC X12N 5010 and NCPDP Frequently Asked Questions (FAQs)

Transactions

837 Institutional and Professional

  1. Do providers who submit paper claims to a clearinghouse, which converts them to an 837 transaction, need to change how they report their Billing Provider Address on paper?

    The Billing Provider Address is the address where the services were rendered and it is required for ASC X12N 5010 837 transactions. The Billing Provider Address must be a street address. Post Office (P.O.) Box or lock box addresses are to be sent in the Pay-To address loop if providers use them as the delivery location for payments. Claims that contain a P.O. Box or lock box address in the Billing Provider Address field will be rejected upon Medi-Cal’s implementation of ASC X12N 5010.

  2. Do providers have to use a nine-digit ZIP code?

    Yes. The ZIP code reported for the Billing Provider Address and Service Facility Locations must be a nine-digit ZIP code or the claim will be rejected upon Medi-Cal’s implementation of ASC X12N 5010. Adding “-0000” to create a nine-digit ZIP code is not acceptable. If a provider does not know his/her nine-digit ZIP code, he/she may contact the local post office or visit the United States Postal Service website. Nine-digit ZIP codes are only required for the Billing Provider Address and Service Facility Locations.

  3. Can providers report a P.O. Box or lock box address in the Billing Provider Address and Service Facility Location fields?

    No. The Billing Provider Address and Service Facility Location must be a street address. P.O. Box or lock box addresses are to be sent in the Pay-To address loop if providers use them as the delivery location for payments. Claims that contain a P.O. Box or lock box address in the Billing Provider Address and/or Service Facility Location field will be rejected upon Medi-Cal’s implementation of ASC X12N 5010.

  4. Should providers in rural locations, who have a P.O. Box because there is no mail delivery, use their mailing address for the Billing Provider Address?

    The Billing Provider Address is the address where the services were provided. Therefore, providers can only use their mailing address if it is the address where the services were provided. The Billing Provider Address must be a street address, not a P.O. Box or lock box address.

  5. How do providers in a rural location determine their street address?

    Providers need to report their physical street address, not a P.O. Box or lock box in the Billing Provider loop. The local post office can provide the street address or best description of the physical location if providers are unsure what to report.

837 Professional

  1. Has there been a change for ambulance or non-emergency transportation services when more than one patient is transported in the same vehicle?

    Yes. A new segment has been added to the ASC X12N 5010 format and is required when more than one patient is transported in the same vehicle for ambulance or non-emergency transportation services. Ambulance information will be reported in the NM1 segment with qualifier PW for pick-up from the pick-up location and qualifier 45 for pick-up from the drop-off location.

835 Electronic Remittance Advice

  1. Will the Medi-Cal 835 file be modified to include claims in a pended status?

    No. The 835 will not be created for pended claims; it is only for claims that have completed the adjudication process.

  2. Will Medi-Cal include the Medi-Cal proprietary Remittance Advice Details (RAD) codes in the 835 transaction?

    No. The Medi-Cal 835 will have the HIPAA-compliant industry codes, not the RAD codes. Providers may refer to the Remittance Advice Details Electronic Correlation Table to National Codes sections for crosswalk listings.

  3. Will Medi-Cal’s 835 transaction include the Payee’s Tax ID Number (TIN)?

    Yes. The 835 transaction will allow the TIN. The TIN will be added to the REF - Payee Additional Information segment in the ASC X12N 5010 format.

  4. Will Medi-Cal continue to provide the Supplemental Claims Payment Information (SCPI) file?

    Yes. The SCPI is an electronic file that contains similar information to the RAD as well as account adjustment information. Files are generated on a weekly basis and available to download from Transaction Services on the Medi-Cal website.

270/271 Eligibility Inquiry/Response

  1. Will Medi-Cal provide the 999 Implementation Acknowledgement?

    Medi-Cal will return the 999 Implementation Acknowledgement transaction on the 270 Eligibility Batch Inquiry only.
  2. Will Medi-Cal continue to provide multiple ways to check eligibility?

    Yes. Medi-Cal offers the following methods for checking beneficiary eligibility:

    • Automated Eligibility Verification System (AEVS)
    • Batch Internet Eligibility through the Medi-Cal website
    • Real-Time Internet Eligibility (RTIE), Single or Multiple Subscriber
    • Point of Service (POS) device
  3. Are there any changes planned for the way that County Mental Health Plans and their contracted providers identify themselves on the ASC X12N 5010 270 transaction to request information from Medi-Cal?

    No changes are planned at this time. Access will be the same as it was prior to implementation of ASC X12N 5010. Providers will continue to use their Provider Identification Number (PIN) to access the Medi-Cal system. Providers can continue to access the Medi-Cal X12 Companion Guide on the Medi-Cal website for up to date information.

276/277 Claim Status Request/Response

  1. Will Medi-Cal continue to provide multiple ways to check claim status?

    Yes. Medi-Cal offers the following methods for checking claim status:

    • Real-Time Direct Data Entry through the Medi-Cal website
    • Batch Inquiry transaction
    • Calling the Telephone Service Center (TSC) at 1-800-541-5555
  2. Will both batch and real-time 276/277 transactions be transitioning to the ASC X12N 5010 standard?

    No. Only the 276/277 batch transaction will be changing to the ASC X12N 5010 standard. The real-time 276/277 transactions that utilize the Medi-Cal website via PTN will be updated for
    ASC X12N 5010 at a later point in time after July 2, 2012. Future notice of the date will be communicated to providers.