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CHDP Notice: Phase 1 Clinical Laboratory Only Transition Update

December 8, 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 HIPAA standards, including the use of national health care electronic transactions and code sets. The transition to bill with national forms (CMS-1500 or UB-04) or equivalent electronic claims is a date of service cutover. Effective for dates of service on or after February 1, 2017, all CHDP clinical laboratory-only services must be billed using HIPAA-compliant standards.

Phased Approach
Transitioning lab providers to submit national CPT-4 codes on CMS-1500, UB-04 or equivalent electronic claims is Phase 1 of an overall CHDP code conversion. Phase 2 will transition CHDP providers who render well-child health assessments, immunizations and lab services in a single encounter to billing with the national claim formats.

Code Crosswalk
A previously published article, CHDP HIPAA Code Conversion for Clinical Laboratory Service Providers Coming Soon, notified providers of the upcoming HIPAA code conversion and claim form transition. The article included a crosswalk of local codes to CPT-4 codes that clinical laboratory providers will bill according to Medi-Cal hard copy or electronic claim submission standards.

Transition Benefits
The transition brings many benefits for CHDP providers who bill laboratory-only claims, including the following:

  • Ability to check claim status during processing
  • Use of HIPAA-compliant claim forms (CMS-1500 and UB-04)
  • Use of HIPAA-compliant ASC X12N 837 v.5010A1 electronic health care transactions
  • Use of HIPAA-compliant CPT-4 codes
  • Use of modifiers
  • Single claim line processing
  • Claims Inquiry Form (CIF) submission for claim adjustments
  • Medi-Cal Appeal Form submission to challenge claim denials
  • Reporting of adjudicated paper claims on Remittance Advice Details (RAD) forms, or electronic claims on 835 Health Care Claim Payment/Remittance Advices
  • Delivery of payment for services provided on the Medi-Cal warrant

Reminder: For providers who are not actively billing on the CMS-1500 or UB-04 claim form, a claim completion, computer-based training (CBT) course is available through the Medi-Cal Learning Portal (MLP).

Providers may submit questions or concerns regarding the CHDP clinical laboratory-only transition to the transition mailbox at CHDPTransition@xerox.com.

Providers are encouraged to watch for CHDP claim submission updates in the NewsFlash area of the Medi-Cal website. Providers are also 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.