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CHDP Notice: Upcoming HIPAA Code Conversion and Claim Form Transition

September 20, 2016

The Department of Health Care Services (DHCS) is continuing its efforts to transition Child Health and Disability Prevention (CHDP) Program policy to comply with Health Insurance Portability and Accountability Act (HIPAA) standards, including the use of national health care electronic transactions and code sets. Throughout the 2017 calendar year, date-of-service-driven CHDP Program policy changes will be implemented in phases to align with HIPAA standards. The first phase is projected to launch in the first quarter of 2017 for clinical laboratory provider services.

The transition includes the following:

  • Use of national, HIPAA-compliant coding standards for CHDP services
  • Adoption of the CMS-1500 and UB-04 claim forms, and the ASC X12N 837 v.5010A1 transaction to replace the following CHDP forms:
    • Standard Confidential Screening/Billing Report (PM 160)
    • Computer Media Claim (CMC) PM 160, electronic claim batch transaction
  • Submission of electronic claims for CHDP services via the HIPAA-compliant 837 standard transaction format or current paper format
  • Reports of the adjudication for CHDP services on Remittance Advice Details (RAD) forms or the 835 Health Care Claim Payment/Remittance Advice (RA)
  • Delivery of payment for CHDP services with the provider’s Medi-Cal warrant
  • Adherence to provider enrollment requirements and compliance for billing requirements with Medi-Cal policies and rates for well-child assessments, including billing of well-child health assessments and immunizations as Medi-Cal services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit for persons under 21 years of age

CHDP providers should continue to submit standard and information-only PM 160 forms until DHCS announces the effective date for the transition.

Providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the transition. These notifications will inform and prepare providers to minimize unnecessary service disruptions. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Additional details regarding this transition will be announced in a future NewsFlash and/or CHDP Update.