The 837 transaction is a fast and paper-free alternative to billing on the CMS-1500 and UB-04 hard copy claim forms. The two most efficient methods of submitting Medi-Cal claims electronically in the 837 v.4010A1 Professional and Institutional transaction formats are through the Computer Media Claims (CMC) and Internet Professional Claim Submission (IPCS) systems.

CMC submissions are used by providers that transmit several claims (typically 50 or more) at one time. These CMC “batch” submissions are transmitted in both 837 v.4010A1 Professional and Institutional formats. Providers are required to have – or contract with – a service that operates a computerized billing system with the ability to submit claims through a dial-up or Internet connection. For more information regarding CMC claim submissions, providers can refer to the CMC section of the Part 1 manual.

IPCS is used by medical providers that only need to submit single claims in the 837 v.4010A1 Professional format. IPCS is only accessible online through the "Transaction Services" area on the Medi-Cal Web site. IPCS lets providers quickly edit and search for the claims they submit. Providers can refer to the IPCS User Guide for requirements and instructions for using this system.

In addition, providers can submit attachments electronically with their 837 v.4010A1 electronic claims submissions through an approved third-party vendor. Third-party vendors preprocess attachments and send the images electronically for the provider to Medi-Cal where they are linked to the corresponding claim. The attachments are transmitted into the system immediately, resulting in faster processing than faxing or mailing. Providers must be authorized to bill 837 v.4010A1 electronic claims and enter into a business agreement with a third-party vendor approved by Medi-Cal to submit electronic attachments. Detailed information about these submissions can be found in the HIPAA: Electronic Attachments for 837 Version 4010A1 Claims Now Available article on the Web site.

Enrollment
Getting started is easy. Simply complete a Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) and a Medi-Cal Point of Service (POS) Network/Internet Agreement. After the forms are sent to EDS and processed, providers will receive a user ID and password that will allow access to the provider’s chosen method for processing Medi-Cal claims online either by CMC or IPCS.

Need More Information?
For more assistance with CMC, electronic attachment submission or IPCS, providers can call the Telephone Service Center (TSC) at 1-800-541-5555, select option 16 from the main menu and follow the prompts.