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CHDP HIPAA Code Conversion and Claim Form Transition Phase II

February 9, 2017

Phase II of the Child Health and Disability Prevention (CHDP) Health Insurance Portability and Accountability Act (HIPAA) code conversion and claim form transition is underway to bring billing for CHDP services into compliance with HIPAA standards for national health care electronic transactions and code sets.

The transition of CHDP claim adjudication to the California Medicaid Management Information System (CA-MMIS) is effective for dates of service on or after July 1, 2017. CHDP well-child health assessments and immunizations will be billed as Medi-Cal services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit for persons under 21 years of age.

Who is Impacted Under Phase II?
The transition includes all remaining CHDP providers that currently provide Medi-Cal EPSDT well-child health assessments, immunizations and ancillary clinical laboratory services. Providers who bill for clinical laboratory-only services should have already transitioned to HIPAA-compliant standards effective for dates of service on or after February 1, 2017.

What is Impacted?
This transition impacts claim submissions using CPT-4 procedure codes on the Health Insurance Claim Form (CMS-1500) and UB-04 claim form or equivalent electronic claim transactions. CHDP EPSDT well-child health assessments and immunizations will be billed as Medi-Cal services in accordance with Medi-Cal policy, rates and provider enrollment requirements. Providers billing for these services will align with Medi-Cal claims processing requirements. Providers will be reimbursed for these services on their Medi-Cal warrant. The adjudication of these services will be reported on the Medi-Cal Remittance Advice Details (RAD) form or 835-Transaction.

When Will Phase II Be Implemented?
Phase II of the transition will be implemented with a date of service cutover of July 1, 2017. All services performed with a date of service on or after July 1, 2017, will be billed using the CMS-1500 or UB-04 claim forms or equivalent electronic claim transactions.

Note:  Services that were provided prior to July 1, 2017, will continue to be billed on the CHDP Confidential Screening/Billing Report (PM 160) claim form.

Providers may submit questions or concerns regarding the CHDP 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 available on the Medi-Cal website.