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What are the steps to become a Computer Media Claims (CMC) Submitter?
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.
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:
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.
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:
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.
How many batches need to pass before submitters are considered to have accomplished the testing process?
One batch per transaction type.
What type of data is required (real-time or test)?
It is recommended that files for previously adjudicated claims be used.
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
What is Medi-Cal’s plan for testing 835 transactions?
Currently there are no plans to test 835 transactions.
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:
Once submitters certify with Medi-Cal, when do they go into production?