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New claim format for Child Health and Disability Prevention Program providers

Historically, fee-for-service Child Health and Disability Prevention (CHDP) program health assessments and immunizations were billed by providers using the proprietary PM 160 claim form or its electronic equivalent.  However, because this claim form applied local codes for the purpose of billing, it did not conform to federal HIPAA laws. In order to comply with HIPAA requirements, the California Department of Health Care Services (DHCS) stopped accepting PM 160 claim forms on July 1, 2017, except for claims with dates of service prior to July 1, 2017. Fee-for-service CHDP claims are ...

Child Health and Disability Prevention code and claim form conversion effective July 1

The California Department of Health Care Services (DHCS) is currently transitioning Child Health and Disability Prevention (CHDP) program billing processes to be compliant with HIPAA standards for national health care electronic transactions and code sets. Rather than billing on the CHDP Confidential Screening/Billing Report (PM 160) claim form, claims will be submitted using CPT codes on the CMS 1500 or UB-04 claim forms or equivalent electronic claim transactions. The transition, effective for dates of service on or after July 1, 2017, affects claims for Medi-Cal Early and Periodic Screening, Diagnosis ...

DHCS preps contingencies in case of delayed budget approval

The California Department of Health Care Services (DHCS) recently announced it will implement a contingency plan for claim payment if the state budget is not enacted before the beginning of the 2017-2018 fiscal year on July 1. Although the state legislature passed a budget by the June 15 deadline, the Governor has not yet signed it. According to DHCS, providers should continue to submit claims for processing as normal, but payments for some programs may be delayed until the budget is signed. Claims for the following services will be processed ...

CHDP group providers must re-attest by April 17 to receive ACA primary rate increase

The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act (ACA) primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Most recently, the California Medical Association learned that CHDP providers practicing as part of a group would be required to re-attest as a group to get paid. Previously, physicians had been instructed to only attest as individuals. DHCS issued an updated “NewsFlash” on March 30 to explain the additional steps that will be required. Groups and clinics that ...

Medi-Cal UCR web app for CHDP primary care rate increases now available; deadline to submit is Nov. 28

The California Department of Health Care Services (DHCS) has taken steps to correct a problem with the Affordable Care Act primary care rate increase unique to Child Health and Disability Prevention Program Services (CHDP) providers. Before the rate increases were implemented, some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lesser of Medicare’s rate or the billed charges—that some practices would not qualify for the retroactive increases once the systems were updated to process claims at ...

DHCS announces additional delays for some ACA Medi-Cal primary care rate increases

The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via ...