Medi-Cal Transitions to CMS-1500 Form and NPI

This bulletin contains provider manual updates based on Medi-Cal's acceptance of the new
CMS-1500 form and advancement to the use of the National Provider Identifier (NPI).

From April 23, 2007 to June 24, 2007, Medi-Cal will accept both the HCFA 1500 and CMS-1500 form. During this transition period, providers are encouraged to migrate their business processes away from the HCFA 1500, depleting their form stock, in preparation for exclusive use of the CMS-1500.

Providers may continue to use the HCFA 1500 form during the transition period and bill as they do currently. Providers using the HCFA 1500, however, can only enter their Medi-Cal provider number.

Providers may choose to fully transition to the new CMS-1500 claim form at any time during this two-month period before the use of the CMS-1500 becomes mandatory. Beginning June 25, 2007, Medi-Cal will only accept the CMS-1500.

Also, beginning May 23, 2007, the NPI, if available, should be reported along with the Medi-Cal provider number, but is not necessary for proper adjudication. The Medi-Cal provider number must be reported on all claims through November 25, 2007. Claims received with only an NPI will not be processed.

Beginning November 26, 2007, providers must use only an NPI when submitting CMS-1500 claims to Medi-Cal.

Pages updated/corrected due to ongoing provider manual revisions:

Part 1 Provider Manual

Subscriber Order Form 1/2
claim sub 1 thru 4
cmc enroll 5/6
elect 1/2
mcp spec 7/8
medicare 11 thru 13
other 5/6
point 1/2
Medi-Cal Point of Service (POS) Network/Internet Agreement 1/2
prog 1/2, 5/6
prov rel 5/6

Part 2 Provider Manual

** Special inserts explaining how to enter provider identifiers during the dual-use period are included with this bulletin. Please place them in your provider manual, according to the instructions below, to help with billing during this period.

Insert at front of manual:	NPI dual-use insert
Remove and replace:	Contents for General Medicine Billing and Policy i thru x
	anest 3/4
Remove:	anest hcfa 1 thru 10
Insert:	anest cms 1 thru 9 (new)
Remove and replace:	blood 1/2, 7 thru 9
Remove:	blood hcfa 1 thru 5
Insert:	blood cms 1 thru 5 (new)
Remove and replace:	cal child bil 1/2
	CCS Program Billing Guidelines 1/2
Remove:	cal child bil hcf 1 thru 3
Insert:	cal child bil cms 1 thru 3 (new)
Remove and replace:	cal child panel 1 thru 4
	cal child sar 1 thru 6
	can detect 11/12, 21/22
Remove:	can detect exh 1 thru 3
Insert:	can detect exc 1 thru 3 (new)
Remove:	cardio bil hcf 1 thru 5
Insert:	cardio bil cms 1 thru 5 (new)
Remove and replace:	chemo 1/2
	children 1/2
Insert after the CIF Submission and Timeliness Instructions section:	NPI dual-use insert
	cms comp 1 thru 23 (new)
	cms spec 1 thru 8 (new)
	cms sub 1 thru 6 (new)
	cms tips 1 thru 4 (new)
Remove and replace:	cont ms 1 thru 4, 7 thru 10
Remove:	dial ex hcfa 1 thru 3
Insert:	dial ex cms 1 thru 3 (new)
Remove and replace:	eval 3 thru 10, 15/16
	fam planning 3/4, 9/10
Remove:	fam planning hcfa 1 thru 3
Insert:	fam planning cms 1 thru 3 (new)
Remove and replace:	forms leg 3/4
	gene 3/4
	gene ex 1 thru 3
	genetic 3 thru 8
Remove:	hcfa comp 1 thru 24
	HIPAA In Review 1
	Code Correlation Guide 1/2
	hcfa spec 1 thru 9
	hcfa sub 1 thru 6
	hcfa tips 1 thru 4
Remove and replace:	hcpcs 1/2
	hospic 1/2, 7
	incont sup com 3 thru 6
Remove:	inject 1 thru 6, 13/14, 53/54, 59
Insert:	inject 1 thru 6, 13/14, 53/54, 59/60
Remove:	inject bil hcf 1 thru 3
Insert:	inject bil cms 1 thru 3 (new)
Remove:	medi cr hcfa 1 thru 20
Replace with:	NPI dual-use insert
	medi cr cms 1 thru 20 (new)
Remove:	medi ex ms 1 thru 3
Insert:	medi cr cms exm 1 thru 3 (new)
Remove:	medi ms 1 thru 9
Insert:	medi cr cms prm 1 thru 9 (new)
Remove and replace:	medi non hcp 1 thru 3
	medne 1/2
	medne neu 1 thru 4
	modif 1/2
	non ph 5/6, 13 thru 15
Remove:	non ph hcfa 1/2
Insert:	non ph cms 1 thru 3 (new)
Remove and replace:	ophthal 1 thru 6
	ophthal cd 1/2
	path an over 1 thru 4
Remove:	path bil hcf 1/2
Insert:	path bil cms 1/2 (new)
Remove and replace:	path hema ex 1 thru 5
	podi 5/6
Remove:	podi hcfa 1 thru 3
Insert:	podi cms 1 thru 3 (new)
Remove and replace:	preg com 1/2, 5/6, 9/10
Remove:	preg com exh 1 thru 9
Insert:	preg com exc 1 thru 9 (new)
Remove:	preg ex hcf 1 thru 13
Insert:	preg ex cms 1 thru 13 (new)
Remove and replace:	preg fetal 1/2
	preg glo 1 thru 3
	preg per 1/2
	presum 19/20
Remove:	radi bil hcf 1 thru 5
Insert:	radi bil cms 1 thru 5 (new)
Remove and replace:	radi dia 23/24
	rates max 3/4, 7/8
	remit pay 1/2
Remove:	share hcfa 1 thru 6
Insert:	share cms 1 thru 5 (new)
Remove and replace:	spec 7
	ster 19/20, 23
	subacut lev 1 thru 4
	surg 3 thru 6
	surg aud 1/2
Remove:	surg bil hcf 1 thru 11
Insert:	surg bil cms 1 thru 11 (new)
Remove and replace:	surg bil mod 7/8
	surg integ 1 thru 4
	transplant 3 thru 8
	tuber 1/2

Use of the new claim forms becomes mandatory on June 25, 2007.  Providers planning to bill using the old claim forms until June 24, 2007 should refer to the following previous manual sections.

anest hcfa 1 thru 10
blood hcfa 1 thru 5
cal child bil hcf 1 thru 3
can detect exh 1 thru 3
cardio bil hcf 1 thru 5
dial ex hcfa 1 thru 3
fam planning hcfa 1 thru 3
gene ex 1 thru 3
hcfa comp 1 thru 24
hcfa spec 1 thru 9
hcfa sub 1 thru 6
hcfa tips 1 thru 4
inject bil hcf 1 thru 3
medi cr hcfa 1 thru 20
medi ex ms 1 thru 3
non ph hcfa 1/2
path bil hcf 1/2
path hema ex 1 thru 5
podi hcfa 1 thru 3
preg com exh 1 thru 9
preg ex hcf 1 thru 13
radi bil hcf 1 thru 5
surg bil hcf 1 thru 11