CHDP Notice: Reminders for Phase 1 Clinical Laboratory Only Transition
Effective for dates of service on or after February 1, 2017, claims for Child Health and Disability Prevention (CHDP) clinical laboratory-only services will be accepted solely on a CMS-1500, UB-04 claim form or equivalent electronic HIPAA compliant format.
To be prepared, providers should review the list of CPT-4 codes that replace the CHDP two-character local codes published in the article, CHDP HIPAA Code Conversion for Clinical Laboratory Service Providers Coming Soon. The article is posted in the NewsFlash area of the Medi-Cal website.Reminders
- Providers must use HIPAA compliant ASC X12N 837 v.5010A1 electronic health care transactions for claims with dates of service on or after February 1, 2017. Providers and submitters who have not been approved to use the HIPAA compliant format should contact the Telephone Service Center (TSC) at 1-800-541-5555 for assistance.
- Claims with dates of service on or before January 31, 2017 must continue to be submitted on the Confidential Screening/Billing Report (PM 160) or using the proprietary computer media claims (CMC) transaction. Claims for these dates of service submitted in the new HIPAA compliant format will be returned to the provider or denied.
- Adjudicated claims with dates of service on or after February 1, 2017 will display on providers’ Medi-Cal Remittance Advice Details (RAD). Helpful information about RADs and payment warrants is located in the Part 1 Medi-Cal provider manual sections, Remittance Advice Details (RAD) and Medi-Cal Financial Summary, and Remittance Advice Details (RAD) and Reconciling Medi-Cal Payment.
- For inquiries about or to request an adjustment to claims with dates of service on or after February 1, 2017, providers may use a Claims Inquiry Form (CIF). Helpful information about CIFs is available in the Part 2 Medi-Cal provider manual section, CIF Completion.
- 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 must not submit CIF inquiries or adjustments about claims with dates of service on or before January 31, 2017. The CIF cannot be processed. Claim inquiries for these dates of service must continue to follow the appeals or balance due procedures outlined in the CHDP Provider Manual.
Providers may submit questions or concerns regarding the CHDP clinical laboratory-only transition to the transition mailbox at CHDPTransition@conduent.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.