What's New

Since May 21, 2007, use of the NPI is allowing some clinic automatic crossover claims into the claims processing system in error. As a result, the following clinic providers who are also billing Medi-Cal directly may be paid for both claims:

• Rural Health Clinics
• Federally Qualified Health Centers (FQHCs)
• Indian Health Services (HIS), Memorandum of Agreement (MOA) 638 Clinics

In order to be paid at the correct rate, these claims should only be billed directly by providers as straight Medi-Cal claims.

Providers Should Continue Direct Billing
Automatic crossover claims will be voided at a later date through the Erroneous Payment Correction (EPC) process and providers will be notified. Providers should continue to direct bill their claims for Medicare/Medi-Cal eligible patients with local code 02 as described in the Provider Manual until instructed otherwise.

CIF Option
Providers who do not want to wait for an EPC letter may complete a Claims Inquiry Form (CIF) to void any automatic crossover claim payments.

CIF completion instructions are included in the CIF Completion and CIF Special Billing Instructions sections in the appropriate Part 2 manual.

Questions may be directed to the Telephone Service Center (TSC) at 1-800-541-5555, option 15 then 15 again.