HIPAA: Testing

  1. What are the steps to become a Computer Media Claims (CMC) Submitter?

    1. Complete a Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) form to get a submitter number. Submitters must use their submitter ID with the prefix “CMCSUB” and password (for example: CMCSUB001).
    2. Set up a password to access the Internet link. Submitters are required to create an eight-character password and provide this password to the CMC Help Desk. Electronic submission tests cannot be processed without a submitter's password. The password will be activated within 48 hours of notification from the submitter.
    3. Send in a test transmission to verify compatibility.
    4. Provider/submitter number is activated by Department of Health Care Services (DHCS) upon successful test transmission.
  2. Will a new CMC submitter ID be required for 5010 or NCPDP D.0/1.2 transactions?

    No, the current 3-digit submitter ID remains in force for the 5010 and NCPDP D.0/1.2 transactions.

  3. Do providers need to complete a new Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153)?

    Providers currently approved to submit transactions electronically to Medi-Cal will not need to complete new paperwork. A Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) is required for providers who are:

    • Not currently submitting transactions electronically
    • Submitting claims on multiple media. Providers must submit an individual application/agreement form for each media format used.
    • Changing their name or provider number. A new submitter number is required and a new application/agreement form must be submitted.
  4. Will Medi-Cal have a testing portal? If so, how is it accessed?

    Test files may be submitted through the Medi-Cal test website at sysdev.medi-cal.ca.gov/MCWebPub/Login.aspx.

  5. Will providers who bill through a clearinghouse be required to link themselves to the clearinghouse's submitter ID?

    No, that linkage will already exist. Proper written notification is required under the following circumstances:

    • Provider changes from Billing Service to Direct Submission:
    • Either the provider or the billing service must submit a letter identifying the billing service and provider numbers involved, as well as the termination date. The provider must submit a new Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153). The provider must then be approved as a Computer Media Claims (CMC) submitter before claims may be submitted through CMC.
    • Provider changes from Direct Submission to Billing Service:
    • A letter that provides the submitter's number, name, and the billing service address is required. The billing service must submit a new Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153).
  6. How many claims are required for testing (minimum/maximum)?

    Test submissions should contain a cross section of claim type data that can be expected in a production environment. The test file must consist of a minimum of 10 claims for each claim type to be billed. A maximum of 100 claims is allowed for testing. The test procedure must be completed for each applicable claim type.

  7. How many batches need to pass before submitters are considered to have accomplished the testing process?

    One batch per transaction type.

  8. What type of data is required (real-time or test)?

    It is recommended that files for previously adjudicated claims be used.

  9. Is Medi-Cal requiring software certification?

    Yes, each submitter must send test files for each transaction and media type they want to submit transactions through. Approval is required for each medium and format, submitters may use the same submitter number for all media and formats.

    Testing instructions and test scenarios can be found in documents located on the Medi-Cal website:

    270 Real-Time Eligibility Test Document
    270 Batch Eligibility Test Document
    NCPDP D.0 Real-Time Test Document

  10. What is Medi-Cal’s plan for testing 835 transactions?

    Currently there are no plans to test 835 transactions.

  11. Are there testing instructions anywhere for submitters to download?

    Test instructions can be found on the Medi-Cal website at these locations, which includes instructions on how to certify software:

  12. Once submitters certify with Medi-Cal, when do they go into production?

    Once testing and certification is successful, submitters should call the CMC Help Desk to schedule the date to go into production for 5010 and NCPDP formats by calling 1-800-541-5555. Choose the appropriate option for language (English or Spanish), option 1 for provider, option 4 for the Technical Help Desk, followed by option 2 for the CMC Help Desk.