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CHDP Phase 2 Correction: PM 160 Information Only Required for FQHCs, RHCs and IHS/MOAs

May 3, 2017

Federally Qualified Health Center (FQHC) providers received a letter in February 2017 that included information on the Child Health and Disability Prevention (CHDP) HIPAA code conversion and claim form transition and the impact of this change to FQHCs, Rural Health Clinics (RHCs) and Indian Health Services, Memorandum of Agreement 638 (IHS/MOA) clinics that bill Medi-Cal for cost-based reimbursement for CHDP/EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) well-child health assessments on the X12N 837I/UB-04 outpatient claim.

The communication stated that providers would no longer be required to submit the CHDP Confidential Screening/Billing Report (PM 160 Information Only) to document child health assessment encounters for dates of service on or after July 1, 2017.

However, it has been determined the PM 160 Information Only form will need to be submitted as an attachment with the X12N 837I/UB-04 outpatient claim until further notice.

There will be no other changes in current billing processes for FQHC, RHC and IHS/MOA providers as a result of this transition of CHDP claims.

Providers are encouraged to watch for CHDP updates in the NewsFlash area on the Medi-Cal website, and subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to CHDP by completing the MCSS Subscriber Form.

Providers with questions or concerns may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Email Address for Questions/Concerns
Providers may submit questions or concerns regarding the CHDP code conversion and claim form transition to CHDPTransition@conduent.com.