Previous Medi-Cal Newsroom Articles
- 837 Transaction
- BCCTP
- BIC Update
- Billing
- Budget
- Bulletin Announcements
- Cancer Detection Programs
- Child Health and Disability Prevention Program
- Claims
- County Medical Services Program
- DHCS Notice
- Durable Medical Equipment
- Education & Outreach
- eTAR
- Federal Deficit Reduction Act 2005
- Forms
- Internet Professional Claim Submission
- Pharmacy
- POS Device/Network
- Provider Enrollment
- Rate Adjustments
- Telephone Service Center
- Transaction Services
- Women, Infants and Children
837 Transaction
Benefits of Submitting Claims Electronically – The 837 transaction is a fast and paper-free alternative to billing on the CMS-1500 and UB-04 hard copy claim forms. (January 2008)
Electronic Attachments for 837 Claims – 837 v.4010A1 claim attachments can now be submitted electronically.
837 Professional Claim Transaction Available on the Medi-Cal Web Site – Did you know that Allied Health, Medical Services (General Medicine and Obstetrics) and Pharmacy providers can submit claims for medical services and supplies using the Medi-Cal Web site?
BCCTP
BCCTP Update – On January 1, 2002, the new Breast and Cervical Cancer Treatment Program (BCCTP) began providing Medi-Cal benefits for the treatment of breast and/or cervical cancer.
BIC Update
SSNs Prohibited: Summer 2007 Implementation – Always Take Your BIC With You notice is now available in multiple languages.
BICs Replacing SSNs Notice – Recipient outreach continues regarding SSN policy change.
Medi-Cal BIC Update – Statewide issuance of new 14-character BICs is now complete.
Billing
Mass Deactivation of Non-Participating Providers and Resulting Effect on NPI Registration – The Department of Health Care Services (DHCS) conducts periodic deactivations of providers that have not billed Medi-Cal for 12 consecutive months and is not required to provide notice to the affected providers.
Deferred TAR Attachment Update – Effective November 15, 2006, attachments for deferred paper TARs will not be returned.
SSN Policy Change Delay – Implementation of new billing requirements that prohibit use of a recipient’s SSN delayed until further notice.
ADHC Update – Effective retroactively to May 1, 2006, new guidelines have been implemented for ADHC providers to clarify number of days and carry-over days.
Reminder to Use Correct Billing Modifiers – Date of service determines the recently implemented modifiers.
Budget
Status of Provider Reimbursement After Budget Signing – Medi-Cal will process pending claims for payment over the coming weekend.
2007 – 2008 State Budget Reimbursement Contingency– DHCS will direct EDS to continue processing claims if the state budget is not signed by June 30.
2004 - 2005 State Budget Signed – The 2004-05 State budget was signed on July 31, 2004.
(updated August 2, 2004)
2003 Budget Act: Provider Payment Reductions – Effective for dates of service on or after January 1, 2004, Medi-Cal will reduce payments for services by five percent.
2003 - 2004 State Budget Reimbursement Contingency - IMPORTANT NOTICE: The State budget for fiscal year 2003 - 2004 was not enacted by June 30, 2003. As a result, the Department of Health Care Services (DHCS) has directed EDS to implement provisions to continue reimbursing most program’s claims and to withhold reimbursement on claims for programs for which contingency funding is not available.
Bulletin Announcements
Bulletin Archives Expanded – Providers can now access 12 months of Medi-Cal Update archives online.
Cancer Detection Programs
CDP: EWC Step-By-Step Provider User Guide – The Cancer Detection Programs: Every Woman Counts Step-By-Step User Guide has been revised with the following.
CDP: EWC Mammography Policy Clarification – Mammography policy stated in Medi-Cal Updates also applies to CDP: EWC with the exception of digital mammography.
Cancer Detection Programs Provider User Guide Update – View a list of updates, including new content, expanded sections and instructions.
Cancer Detection Programs: Every Woman Counts – Providers participating in Cancer Detection Programs: Every Woman Counts can search the entire online recipient database when completing Web data forms, enrolling recipients or re-certifying recipients.
CDP: EWC Step-By-Step Provider User Guide – The Cancer Detection Programs: Every Woman Counts Step-by-Step Provider User Guide is designed to help you navigate the Cancer Detection Programs Application on the Medi-Cal Web site.
Child Health and Disability Prevention Program
CHDP Electronic Claim Transaction Format Update – The Child Health and Disability Prevention (CHDP) program's proprietary electronic claim transaction formats will be modified to accommodate use of the National Provider Identifier (NPI) and several new fields that have been added to the CHDP Confidential Screening/Billing Report (PM 160) and Confidential Screening/Billing Report Information Only (PM 160 Information Only) claim forms.
New CHDP pre-enrollment process – Effective July 1, 2003, Child Health and Disability Prevention (CHDP) program providers can now pre-enroll children in the Medi-Cal program by using the new CHDP Gateway on either the Medi-Cal Web site or a Point of Service (POS) device.
Claims
SCPI Manual Update to OHC Carrier Data – Effective August 25, 2008, the Other Health Coverage (OHC) Carrier Data (C1) 2.1.9 and 3.1.8 record layout specifications will be updated in the Supplemental Claims Payment Information (SCPI) User Guide.
Tamper-Resistant Prescription Pads Requirement Update – Effective April 1, 2008, all written, non-electronic prescriptions must be executed on tamper-resistant pads, in order for Medi-Cal outpatient drugs to be reimbursable by the federal government.
Reminder: Include CMC Attachments with the ACF – The Attachment Control Form (ACF) allows providers to include supporting documentation with their Computer Media Claims (CMC).
CMS-1500 and UB-04 Tutorials Updated with NPI Changes – Effective December 17, 2007, the date of NPI implementation, Medi-Cal providers can use the National Provider Identifier (NPI) for all claims and provider transaction services.
Tamper-Resistant Prescription Pads Requirement –New federal legislation requires that effective April 1, 2008, in order for Medi-Cal outpatient drugs to be reimbursable by the federal government, all written, non-electronic prescriptions must be executed on tamper-resistant pads.
Nine-Digit ZIP Code Encouraged on Claims – As a result of the National Provider Identifier (NPI) implementation, providers should submit a nine-digit ZIP code when entering service address information on claims, effective November 26, 2007. (October 2007)
SCPI Manual Now Available on the Medi-Cal Web Site – The Supplemental Claims Payment Information (SCPI) manual, formerly called the Automated Remittance Data Services (ARDS) manual, was updated in conjunction with the rollout of National Provider Identifier (NPI) numbers.
Inpatient Crossover Claims Update – Effective October 1, 2007, hard copy inpatient crossover claims with certain billing errors will be returned.
New Claim Form Submission Reminders – Guidelines for submitting the new CMS-1500 and UB-04 claim forms.
Claim Form Billing Reminder – Effective June 25, 2007, providers can only submit the new CMS-1500 and UB-04 claim forms.
Printing UB-04 Claim Forms – Requirements to meet the UB-04 print specification.
Special Claims Review FAQs Updated – Updated answers to provider questions about SCR now available.
New Medicare Policy for Dialysis Providers – Effective April 1, 2007, ESRD facilities must bill services separately by service date. (Updated 3/19)
Crossover Claims NPI Update – Register NPI with Medi-Cal before May 23, 2007 to avoid rebilling crossover claims.
Institutional Crossover Claims NPI Error – COBC is implementing a Part A 837 crossover claim system fix.
Institutional Crossover Claims Update – A system fix has been implemented to improve crossover claims processing.
Crossover Claims Urgent Update – Claims Appeal status now available via the PTN and the Medi-Cal Web site.
Claims Appeal Status – Automatic crossover claims blling tips.
Comment Periods for UB-04 and CMS 1500 Claim Forms – Providers are invited to submit comments about UB-04 Claim Form implementation and CMS 1500 claim form changes.
Pre-Checkwrite Review of Claims – Effective for dates of payment on or after July 1, 2004, the Department of Health Care Services (DHCS) has implemented a new process to monitor Medi-Cal claims.
County Medical Services Program
County Medical Services Program: Benefit Update – Effective for dates of service on or after April 1, 2003, County Medical Services Program (CMSP) prescription drug benefits are provided under a contract with MedImpact Healthcare Systems, Inc. (MedImpact), a pharmacy benefit management company.
DHCS Notice
Department of Health Care Services Reorganization – Effective July 1, 2007, certain responsibilities held by the Department of Health Care Services (DHCS) were transferred to the new California Department of Public Health (CDPH).
IUD Investigation Underway – DHCS reviewing records of eight Southern California physicians.
Hurricane Katrina – Evacuees currently enrolled in Medicaid in their home state are eligible for Medi-Cal services
Elimination of Taxpayer-Provided Erectile Dysfunction Drugs for Sex Offenders – See Governor Arnold Schwarzenegger's directive.
Durable Medical Equipment
DME Providers: Billing Assistance and Grace Period for Coding – Specialized assistance for billing issues is now available via the TSC.
DME, O & P and Clinical Laboratory Services Reimbursement Methodology Changes – Effective for dates of service on or after October 1, 2003, reimbursement methodology for Durable Medical Equipment (DME), Orthotic and Prosthetic (O & P) appliances and clinical laboratory services is changed.
Education & Outreach
eTAR Pharmacy Web-based Tutorial – Now available for eTAR Pharmacy NCPDP Internet transactions.
eTAR
Entering Hospital Days on First Service Line on eTARs – Providers who submit for hospital days on eTARs must enter this information on service line one. Additional procedures should be requested on subsequent service lines to prevent claim submission problems.
Adjudication Response Clarifications for eTAR Providers – Electronic Treatment Authorization Request (eTAR) providers will not receive Adjudication Responses (ARs) unless the service category is either “Pharmacy” or “Vision,” and a valid fax number is included in the Fax Number field.
New Inquire Only Function for TARs – The electronic Treatment Authorization Request (eTAR) Inquire Only functionality for viewing TARs is now available to Medi-Cal providers, including inpatient services providers.
New Fax Option Available for Adjudication Responses (ARs) – Effective July 2007, the Department of Health Care Services (DHCS) implemented the Adjudication Response (AR) in order to reduce the volume of documents containing Protected Health Information (PHI).
TAR Adjudication Response (AR) Notice Update – The Adjudication Response (AR) notice displays Treatment Authorization Request (TAR) service information necessary for submitting claims or responding to requests from the Medi-Cal field office.
Multiple Address Screen eTAR – Upon NPI implementation, select providers will have multiple addresses linked to their National Provider Identifier (NPI). (December 2007)
Attention Providers: Prepare for the Adjudication Response – The Department of Health Care Services (DHCS) will soon discontinue the practice of returning adjudicated paper Treatment Authorization Request (TAR) copies to providers.
Treatment Authorization Request (TAR) Changes – TAR processing changes are being implemented May 1, 2007.
eTAR Available to More Providers – Effective January 15, 2007, eTAR is available for 11 more provider types and services.
eTAR Attachment Guidelines – Guidelines for uploading attachments with eTARs.
ADHC eTAR Submission Option Available – The eTAR Internet application is now available to all ADHC providers.
eTAR Available for Select Providers – The eTAR submission process is now available to 13 more provider types.
eTAR Pharmacy Attachments – New attachment options are available for NCPDP Pharmacy eTARs.
eTAR Pharmacy Web-based Tutorial – Now available for eTAR Pharmacy NCPDP Internet transactions.
Pharmacy eTAR Updates – Fax back response and multiple TAR inquiry now available.
TAR and eTAR Processing Clarification – Providers may not update paper TARs using the eTAR system.
eTAR Available to More Providers – On October 2, 2006, the eTAR submission process was made available to 13 more provider types.
eTAR Submission Guidelines – eTARs submitted for non-benefit services that do not require a TAR will reject and will need to be corrected.
Federal Deficit Reduction Act 2005
Federal Deficit Reduction Act 2005 – Citizenship and Identity Requirements – The August 2007 Medi-Cal Update instructed providers how to help Medi-Cal applicants and beneficiaries meet the citizenship and identity requirements of the federal Deficit Reduction Act (DRA).
Federal Deficit Reduction Act 2005: Employee Education on False Claims Recovery – Effective January 1, 2007, providers must certify that they comply with Section 1902(a) of the Social Security Act.
Federal Deficit Reduction Act 2005 – Medicaid citizenship requirements for California.
Forms
Cutoff Date Extension for Old Claim Forms – Beginning September 17, 2007, claims received on the old HCFA 1500 or UB-92 claim forms will be rejected and returned to the provider.
Reminder: New Proprietary Forms Now Available – New versions of Medi-Cal and Child Health and Disability Prevention (CHDP) proprietary forms are available from Medi-Cal.
UB-04 Claim Form Clarification – For correct use of the UB-04 form for claim submissions, fields 57A through C should be filled out only by “atypical” providers.
Internet Professional Claim Submission
Internet Professional Claim Submission (IPCS) System – The Internet Professional Claim Submission (IPCS) System is now available for submitters with Internet access. This new application was designed for professional medical providers who submit single, professional claims to Medi-Cal.
Pharmacy
Medi-Cal POS NCPDP Pharmacy Transaction Specifications Third Party Vendors (Dial-Up and Leased-Line) Update – The Medi-Cal POS NCPDP Pharmacy Transaction Specifications, Third Party Vendors (Dial-Up and Leased-Line) document has been updated to conform with the National Council for Prescription Drug Programs (NCPDP) standards for the National Provider Identifier (NPI).
Pharmacy TAR (50-1) and eTAR Submission Tips – The following tips have been provided to help make the Treatment Authorization Request (TAR) process for paper and Internet submissions more effective.
Pharmacy Claim Form (30-1) Completion Billing Tips – Providers billing on version 8 of the Pharmacy Claim Form (30-1) should follow the instructions listed below when completing the Metric Quantity fields (Boxes 13, 32, 51 and 70 as applicable). (January 2008)
Application for Enrollment in HIV/AIDS Pharmacy Pilot Project – As previously announced, the Department of Health Care Services (DHCS) is initiating an HIV/AIDS Pharmacy Pilot Project on January 1, 2005. (November 2004)
Pharmacy Update – (last updated 12/16/2002) On April 29, 2002, Medi-Cal upgraded its pharmacy claims processing system to National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard, Version 5.1 for online, real-time submission of pharmacy claims and NCPDP Batch Standard, Version 1.1 for batch submission of pharmacy claims.
POS Device/Network
POS Device Automatic Software Update – A software update to POS devices is scheduled for August 25, 2007.
Family PACT Transaction Now Available on the VeriFone Omni 3300 POS Device – The Family PACT (Family Planning, Access, Care and Treatment) transaction is now available on the VeriFone Omni 3300 Point of Service (POS) device. (August 2004)
Provider Enrollment
AB 1226 – Provider Enrollment Forms & Provisions Effective July 1, 2008 – Effective for dates of service on or after July 1, 2008, Welfare and Institutions (W&I) Code, Section 14043.26(b) and (e) allow doctors of medicine and osteopathic physicians who meet specified criteria, and who change their business locations within the same county, to use a “change of location” form.
Provider Enrollment Application Changes Due to NPI – Effective February 15, 2008, in accordance with Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising all provider enrollment application forms to accommodate the National Provider Identifier (NPI).
Assembly Bill 1226 – Provisions Affect All Providers – Effective for dates of service on or after January 1, 2008, Assembly Bill (AB) 1226 has two provisions, that affect all providers, and that amend the laws the Department of Health Care Services (DHCS) uses to review provider applications for participation in the Medi-Cal program.
New Provider Enrollment Forms Requirement – Effective May 23, 2007, only the current versions (dated 3/07) of the provider application forms will be accepted.
Providers Selling or Purchasing a Business – Requirements and procedures for successor liability.
Provider Enrollment Changes – Revised provider enrollment regulations and updated enrollment forms (DHS 6208 and 6210) are available and effective immediately. Applications submitted on earlier versions of the forms and received after February 1, 2003 will be returned to the sender for resubmission.
Rate Adjustments
Speech Generating Devices Reimbursement Increase – Effective for service dates on or after July 30, 2005.
Telephone Service Center
TSC Phone Menu Prompt Options Guide – Save time and get the assistance you need faster by printing this guide and keeping it next to your phone.
Transaction Services
Transaction Service Redesign Now Complete – As of February 25, 2008, the Transaction Services area on the Medi-Cal Web site features a new “look-and-feel” to comply with state-mandated policy and design standards for all California government agency and department Web sites.
Women, Infants and Children
New Formula Contract in the California Women, Infants and Children Supplemental Nutrition Program –Effective August 1, 2003, the California Women, Infants and Children Supplemental Nutrition Program (WIC) is changing infant formula contractors.