This category includes FAQs on the CMS-1500 and UB-04 claim forms.

For additional questions regarding NPI, contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then select option 18 from the submenu.

A. CMS-1500 Claim Form

1. When are providers required to bill Medi-Cal using their National Provider Identifier (NPI) on the new CMS-1500 claim form?
   A: Effective December 17, 2007, the Department of Health Care Services (DHCS) only accepts either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Atypical providers will continue to use their Medi-Cal provider number.
2. Are there classes available for completing the new CMS-1500 claim form?
   A: Classes on claim form completion are part of the Medi-Cal seminars. A list of upcoming seminars may be viewed on the Training Seminars page. An eLearning tutorial is also available on the eLearning page.
3. Does the Outside Lab field require the Clinical Laboratory Improvement Amendment (CLIA) number or the NPI on the CMS-1500 claim form?
   A: The Outside Lab field (Box 20) does not require the CLIA number or the NPI. If a claim includes charges for laboratory work performed by a licensed laboratory, enter an “X” in this box. “Outside” laboratory refers to a laboratory not affiliated with the billing provider. State in the Reserved for Local Use field (Box 19) that a specimen was sent to an unaffiliated laboratory. Leave blank if not applicable.
back to top

B. UB-04 Claim Form

4. When are providers required to bill Medi-Cal using their NPI on the new UB-04 claim form?
   A: Effective December 17, 2007, DHCS only accepts either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Atypical providers will continue to use their Medi-Cal provider number.
5. If a provider chooses to obtain one NPI to replace multiple Medi-Cal provider numbers, which provider number must be reported on the UB-04 claim form?
   A: Effective December 17, 2007, providers will no longer need to report the Medi-Cal provider number with the NPI on the claim. DHCS will only accept either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Atypical providers will continue to use their Medi-Cal provider number.
   
   By choosing to replace multiple Medi-Cal provider numbers with one NPI, the current multiple “pay-to” addresses, electronic funds transfer (EFT) accounts and provider identification numbers (PINs) will no longer be used. The “pay-to” address, EFT account and PIN information on the first Medi-Cal or CHDP number entered in the online registration tool or designated on the hard copy registration form will be transferred to the new NPI record.
6. Are there classes available for completing the new UB-04 claim form?
   A: Classes on claim form completion are part of the Medi-Cal seminars. A list of upcoming seminars may be viewed on the Training Seminars page. An eLearning tutorial is also available on the eLearning page.
back to top

C. Proprietary Claim Forms

7. When can orders for the new proprietary forms that accommodate the NPI be requested?
   A: Orders for the updated proprietary claim forms, such as the Confidential Screening/Billing Report (PM 160), began May 1, 2007. However, these forms have only been available for distribution since July 2007.
8. Should the NPI be reported on all proprietary forms effective December 17, 2007?
   A: Effective December 17, 2007, DHCS only accepts either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise.


back to top