Medicaid California
- ► California Medi-Cal Medicaid Home Health (HH), UB-04 Hardcopy
-
This is standard fee-for-service reimbursement for skilled nursing, physical therapy, occupational therapy, speech therapy, medical social services, home health aide, medical supplies other than drugs and biologicals and certain medical appliances. DME cannot be billed with a HHA Medi-Cal provider number. Prior authorization is needed for all services. The billing mode in Administration>Financial>Insurance Codes>General for this insurance code is R.
- ► California Medi-Cal Medicaid Home Health (HH), 837I 4010A1 Electronic
-
The following fields or areas in the application are required for California Medi-Cal Home Health (HH), 837I 4010A1 Electronic:
For the receiver ID, enter the Medi-Cal receiver ID of 610442 in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
For payer's receiver name, enter "Medi-Cal" in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
The Assign Benefits and Rel Infor fields in Patient>Payers>HIPAA are currently set as "Y" by default for each carrier. Change to "N" where applicable.
For the patient's attending physician, enter either the doctor's federal tax ID or Social Security number. When available, enter the Provider Taxonomy Code in Resource>General>Roles.
- ► California Medi-Cal Home Health (HH), 837I 5010A2 Electronic
-
Refer to the California Medi-Cal Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional setup information.
If a patient has a 'Share of Cost' for procedures or services, then the FC value code is automatically generated for each claim with the Total Amount. The automatically generated FC value code can be overridden by entering a value code and Total Amount in Patient>General>Claim Constants.
Note: Ensure that the 23 value code with Spend Down amount is not entered for this claim period in Patient>General>Claim Constants.
The following fields in the application are required for California Medi-Cal Home Health (HH), 837I 5010A2 Electronic.
Enter the Medi-Cal receiver ID of 610442 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Enter Medi-Cal in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the submitter ID assigned by California Medi-Cal in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
For the patient's attending physician, enter either the doctor's federal tax ID or Social Security Number.
- ► California Gold Coast Medicaid Home Health (HH), 837I 5010A2 Electronic
-
Refer to the California Medi-Cal Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional setup information.
The following fields in the application are required for California Medicaid Gold Coast Home Health (HH), 837I 5010A2 Electronic.
Enter 77160 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Enter Gold Coast Health Plan in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the submitter ID assigned by California Gold Coast Health Plan in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
For the patient's attending physician, enter either the doctor's federal tax ID or Social Security Number.
- ► California Medi-Cal Medicaid Hospice (HO), UB-04 Hardcopy
-
Medi-Cal provides standard benefit services as per diem for routine homecare, respite care, general inpatient care and fee-for-service for continuous care and for physician services. This insurance should be defined with a billing mode of "B". The California Medi-Cal Hospice format should be selected under Specialized Formats in Administration>Financial>Insurance Codes>Print Variations.
Room and Board services are also provided for hospice patients. A Room and Board insurance code should be set up to generate a separate claim, but the Room and Board charges must be billed in conjunction with the routine homecare and/or continuous care or as secondary to Medicare.
Hospices must send to EDS a copy of the Medicare claim covering the same dates of service or must enter them in the Remarks field (Box 80), or in the attachment to the claim, the date that Medicare was billed, the concurrent dates of hospice care services and the hospice care codes billed.
Change in type of service should be indicated by a new status line in the Admissions & Status window.
Use the following codes in billing rates to correctly bill hospice services.
General inpatient care (per diem).
Note: Only general inpatient care requires authorization.Revenue code 658 must be used to bill for hospice room and board.
Place of service is required for all the existing billing rates.
If a patient changes facilities, it will be necessary to change this in the Pay Control section (Patient>General>Payers). If the same facility is using multiple billing rates in the claim period with different places of service, the one effective as of the claim through date will be used.
If condition code "Y6" is needed, it must be entered through Patient>General>Claim Constants. This code will cause all other codes to be suppressed.
For more information on hospice billing, visit www.medi-cal.ca.gov and look under Publications> Provider Manuals>Inpatient/Outpatient>Hospice Care Program (HOS)>Billing Examples.
Delay reason code "11" is required of claim is over six months old.
HIPAA-compliant HCPCS codes, plus any required modifiers, must be keyed in Administration>Financial>Billing Rates>Rates. If different combinations of HCPCS/modifiers are needed, a new billing rate must be created for each combination.
Reports the agency's NPI number when selecting the National Provider IDs (NPI) or Legacy IDs and National Provider IDs (NPI) option in Adminstration>Financial>Insurance Codes>NPI.
Reports the agency's Medi-Cal provider number when the Legacy IDs or Legacy IDs and National Provider IDs (NPI) option s selected in Adminstration>Financial>Insurance Codes>NPI.
If submitting additional paperwork, please enter the Document Control Number listed on the CA Medi-Cal form in Patient>General>Claim Constants, FL 64 Line A.
Reports the attending physician's information as the appropriate selection is made in Administration>Financial>Insurance Codes>NPI.
>
Legacy IDs will report the value entered in the License field in Resource>General>Roles.
>
National Provider IDs (NPI) will report the NPI entered in Patient>General>Admissions & Status.
>
will report both of the values above.
Note: Medi-Cal will not accept legacy numbers effective 11/26/2007.
- ► California Medi-Cal Medicaid Hospice (HO), 837I 4010A1 Electronic
-
Refer to the documentation notes for the California Medi-Cal Medicaid Hospice (HO), UB-04 Hardcopy format for additional setup instructions. The following fields or areas in the application are required:
Certain Medi-Cal claims require supporting documentation that must be sent by mail or fax to CMC as an "attachment" to the claim. Electronic claims require the ACN number to be included in the file, therefore you must enter the appropriate 11-digit ACN number for FL/Box/Item: 64 - Document Control Number - Line A through Patient>General>Claim Constants.
The electronic claim must also indicate if the documentation is to be mailed or faxed.>
>
For values other than "BM", a value must be entered in Patient>General>Claim Constants for FL/Box/Item: 64 - Document Control Number - Line B.
>
For the receiver ID, enter the Medi-Cal receiver ID of "610442" in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
For payer's receiver name, enter "Medi-Cal" in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
The Assign Benefits and Rel Infor fields in Patient>Payers>HIPAA are currently set as "Y" by default for each carrier. Change to "N" where applicable.
For the patient's attending physician, enter the doctor's NPI. When available, enter the provider taxonomy code.
Medi-Cal requires additional information to adjudicate some Room and Board claims and hospice claims. Since they also require listing the dates of service in the electronic remarks when reporting any level of care that can use "from-thru" billing, the agency entered remarks must be limited to 30 characters.
See some examples of acceptable entries below:If reporting that Room and Board admission started in the middle of May, enter "SOC-met@LTC 5/1-5/10"
If beneficiary has no Medicare benefit, enter "No Medicare Part A benefit".
- ► California Medi-Cal Hospice (HO), 837I 5010A2 Electronic
-
Refer to the California Medi-Cal Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
If a patient has a 'Share of Cost' for procedures or services, then the FC value code is automatically generated for each claim with the Total Amount. The automatically generated FC value code can be overridden by entering a value code and Total Amount in Patient>General>Claim Constants.
Note: Ensure that the 23 value code with Spend Down amount is not entered for this claim period in Patient>General>Claim Constants.
The following fields in the application are required for the California Medi-Cal Hospice (HO), 837I 5010A2 Electronic.
Certain Medi-Cal claims require supporting documentation that must be sent to CMC as an "attachment" to the claim. To enter the ACN number, perform the following actions:
1.
2.
In the FL/Box/Item column, select 64 - Document Control Number - Line A.
3.
In the Value column, enter the appropriate 11-digit ACN number.
The electronic claim must also indicate if the documentation must be mailed or faxed.
By default, By Mail or BM is selected. If needed, enter the value other than BM in Patient>General>Claim Constants for FL/Box/Item set to 64 - Document Control Number - Line B. To indicate that the documentation is to be sent by fax, enter By Fax or FX.
Enter the Medi-Cal receiver ID of 610442 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Enter Medi-Cal in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the submitter ID assigned by California Medi-Cal in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Yby default for each carrier. Change to N where applicable.
For the patient's attending physician, enter the doctor's NPI in the Individual NPI field.
Select the provider taxonomy code in the Provider Taxonomy field.
Medi-Cal requires additional information to adjudicate some room and board and hospice claims. The agency remarks must be limited to 30 characters. For Medi-Cal, list the dates of services in the electronic remarks when reporting any level of care that uses the "from-thru" billing.
Examples of acceptable entries:
>
If reporting that the room and board admission started in the middle of May, enter SOC-met@LTC 5/1-5/10.
>
If beneficiary has no Medicare benefit, enter No Medicare Part A benefit.
- ► California Medi-Cal Hospice (HO) Room & Board Non Standard, 837I 5010A2 Electronic
-
The 837I 5010 California Medicaid Hospice Room & Board Non Standard billing template allows your agency to submit claims electronically. However, this template is not compliant with ANSI 5010 standards. If your agency decides to use this option, you acknowledge that this template does not meet ANSI 5010 standards and is to be used at your own discretion and risk. Your agency will be solely responsible for any audits, fines and fees that may result from the use of this template.
Refer to the California Medi-Cal Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
If a patient has a 'Share of Cost' for procedures or services, then the FC value code is automatically generated for each claim with the Total Amount. The automatically generated FC value code can be overridden by entering a value code and Total Amount in Patient>General>Claim Constants.
Note: Ensure that the 23 value code with Spend Down amount is not entered for this claim period in Patient>General>Claim Constants.
The following fields in the application are required for this template.
Certain Medi-Cal claims require supporting documentation that must be sent to CMC as an "attachment" to the claim. To enter the ACN number, perform the following actions:
1.
2.
In the FL/Box/Item column, select 64 - Document Control Number - Line A.
3.
In the Value column, enter the appropriate 11-digit ACN number.
The electronic claim must also indicate if the documentation must be mailed or faxed.
By default, By Mail or BM is selected. If needed, enter the value other than BM in Patient>General>Claim Constants for FL/Box/Item set to 64 - Document Control Number - Line B. To indicate that the documentation is to be sent by fax, enter By Fax or FX.
Enter the Medi-Cal receiver ID of 610442 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Enter Medi-Cal in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the submitter ID assigned by California Medi-Cal in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Yby default for each carrier. Change to N where applicable.
For the patient's attending physician, enter the doctor's NPI in the Individual NPI field.
Select the provider taxonomy code in the Provider Taxonomy field.
Medi-Cal requires additional information to adjudicate some room and board and hospice claims. The agency remarks must be limited to 30 characters. For Medi-Cal, list the dates of services in the electronic remarks when reporting any level of care that uses the "from-thru" billing.
Examples of acceptable entries:
>
If reporting that the room and board admission started in the middle of May, enter SOC-met@LTC 5/1-5/10.
>
If beneficiary has no Medicare benefit, enter No Medicare Part A benefit.
- ► California Gold Coast Medicaid Hospice (HO), 837I 5010A2 Electronic
-
Refer to the California Medi-Cal Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
The following fields in the application are required for California Medicaid Gold Coast Hospice (HO), 837I 5010A2 Electronic.
Enter 77160 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Enter Gold Coast Health Plan in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the submitter ID assigned by California Gold Coast Health Plan in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
For the patient's attending physician, enter either the doctor's federal tax ID or Social Security Number.
- ► California Medi-Cal Partnership Medicaid Hospice (HO), UB-04 Hardcopy
-
Medi-Cal Partnership provides standard benefit services as per diem for routine homecare, respite care, general inpatient care, and fee-for-service for continuous care and for physician services.
In Administration>Financial>Insurance Codes>General, select the B (Benefit) mode.
Room and board services are also provided for hospice patients. A room and board insurance code must be set up to generate a separate claim, but the room and board charges must be billed together with the routine homecare and/or continuous care or as secondary to Medicare.
Hospices must send to EDS a copy of the Medicare claim covering the same dates of service or enter them in the Remarks field (FL 80); or send the date that Medicare was billed, the concurrent dates of hospice care services, and the hospice care codes billed in the attachment to the claim.
Changes in the type of service must be indicated by a new status line in Patient>General>Admissions & Status.
Use the following codes in billing rates to correctly bill hospice services:
>
>
Room and board codes – Revenue code 658 must be used to bill for hospice room and board.
Place of service is required for all existing billing rates.
If a patient changes facilities, change the facility in the Pay Control section in Patient>General>Payers. If the same facility is using multiple billing rates in the claim period with different places of service, the facility effective as of the claim through date is used.
If needed, enter condition code Y6 in Patient>General>Claim Constants. This code will suppress printing all other codes.
In Administration>Financial>Insurance Codes>Print Variations, define the following items for California Medi-Cal Partnership Hospice (HO), UB-04 Hardcopy.
Enter the delay reason code 11 if a claim is over six months old.
If needed, enter HCPCS codes and the required modifiers in the HCPCS/HIPPS Code field in Administration>Financial>Billing Rates>Rates. If different combinations of HCPCS and modifiers are needed, create a new billing rate for each combination.
Reports the agency's NPI number when the National Provider IDs (NPI) or Legacy IDs and National Provider IDs (NPI) radio button is selected in Administration>Financial>Insurance Codes>NPI.
Reports the agency's Medi-Cal provider number when the National Provider IDs (NPI) or Legacy IDs and National Provider IDs (NPI)radio button is selected in Administration>Financial>Insurance Codes>NPI.
If submitting additional paperwork, enter the Document Control Number listed on the CA Medi-Cal form in Patient>General>Claim Constants.
Reports the attending physician's information and the NPI number when the National Provider IDs (NPI) or Legacy IDs and National Provider IDs (NPI) radio button is selected in Administration>Financial>Insurance Codes>NPI.
- ► California Medi-Cal Partnership Medicaid Hospice (HO), 837I 4010A1 Electronic
-
Refer to the California Medi-Cal Partnership Medicaid Hospice (HO), UB-04 Hardcopy instructions for other setup information.
The following fields in the application are required for California Medi-Cal Partnership Hospice (HO), 837I 4010A1 Electronic.
The Assign Benefits and Rel Infor fields in Patient>Payers>HIPAA are currently set as "Y" by default for each carrier. Change to "N" where applicable.
Enter your employer tax ID in Federal Tax ID field in Administration>Configuration>Business Units>Team and Legal Entities>Legal Entities.
For the patient's attending physician and referring physician, enter either the physician's federal tax ID or SSN.
Enter the physician's taxonomy code.For each operator creating electronic billing files, enter their resource ID in Administration>Configuration>Operators>ID.
In Administration>Financial>Insurance Codes>General, complete the Provider Taxonomy Code field.
For payer's receiver name, enter "PARTNERSHIP HEALTHPLAN OF CA" in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
To indicate that you want to receive a paper EOB,
select the Request Paper EOB check box in Administration>Financial>Insurance Codes.
Enter the first 12 digits of the submitter ID assigned to you by the Partnership Healthplan in the Provider ID field in Administration>Financial>Insurance Codes>EMC.
Note: The HIPAA template will automatically add three zeros following the submitter ID present in the above field to comply with the requirements of Partnership Healthplan.Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
- ► California Medi-Cal Partnership Medicaid Hospice (HO), 837I 5010A2 Electronic
-
Refer to the California Medi-Cal Partnership Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
For California Medi-Cal Partnership Hospice (HO), 837I 5010A2 Electronic, define the following items:
>
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance.
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
>
Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
The following fields in the application are required for California Medi-Cal Partnership Hospice (HO), 837I 5010A2 Electronic.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
Enter the employer tax ID in the Federal Tax ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
For the patient's attending physician and referring physician, enter either the physician's federal tax ID or Social Security Number.
Enter the physician's taxonomy code.For operators creating electronic billing files, enter their resource ID in the ID column in the Patient ID section in Administration>Configuration>Operators>Basic.
Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
Enter PARTNERSHIP HEALTH PLAN OF CA in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
Enter the first 12 digits of the submitter ID assigned by the Partnership Healthplan in the Submitter ID field inAdministration>Financial>Insurance Codes>EMC.
Note: The HIPAA template automatically adds zeros after the entered submitter ID to comply with the requirements of the Partnership Healthplan.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
- ► California Medi-Cal AIDS Waiver, UB-04 Hardcopy
-
The Medi-Cal AIDS Waiver Program is a fee-for-service claim. All print variations defined below should be used for this format. In Administration>Financial>Insurance Codes, this insurance code should be defined as the type K, billing mode R, and state CA. A standard red UB-04 claim form must be used.
FL 3 (Patient Control Number): Use Patient>General>Claim Constants to enter the patient's Waiver Identification Number, as required by Medi-Cal.
FL 4 (Type of Bill): The system will generate all valid values for the third digit (claim frequency) of the type of bill. However, Medi-Cal cannot process credits or adjustments using the UB-04 claim form. Refer to the CIF Completion and CIF Special Billing Instructions for the Outpatient Services section in the Provider Manual for information regarding claim adjustments.
FL 24–30 (Condition Codes): Use Patient>General>Claim Constants to enter the required codes if applicable.
FL 37A (Unlabeled): Use Patient>General>Claim Constants to enter one of the following delay reason codes and include the required documentation if there is an exception to the six-months-from-the- month-of service billing.
Administrative delay in prior approval process (decision appeals)
FL 39–41 (Value Codes): If the patient has a 'Share of Cost' for the procedures or services, enter code 23 with the dollar amount via Patient>General>Claim Constants.
FL 50 (Payer): Medi-Cal requires that you report the Medi-Cal payer name as O/P MEDI-CAL. Use Administration>Financial>Insurance Codes to enter this value in the Payer Name field.
>
Suppress dots & dashes in ICD codes, dates and insured info.
>
In Administration>Financial>Insurance Codes>Print Variations, select the print variations outlined below. All other locators are standard.
Use Patient>General>Claim Constants to enter the patient's Waiver Identification Number.
Suppress printing Value Code 44.
Use Patient>General>Claim Constants to enter other codes if applicable.
Billing Detail Locators 42-47 Rules for all Claims
Print total line on line 22 in revenue section.
- ► California Medi-Cal AIDS Waiver, 837I 4010A1 Electronic
-
Refer to the documentation notes for California Medi-Cal AIDS Waiver, UB-04 Hardcopy instructions for additional setup information.
FL31 (Unlabeled): Use Patient>General>Claim Constants to enter one of the following delay reason codes and include the required documentation if there is an exception to the six-months-from-the- month-of service billing.
Administrative delay in prior approval process (decision appeals)
The following fields or areas in the application are required.
The Assign Benefits and Rel Infor fields in Patient>Payers>HIPAA are currently set as "Y" by default for each carrier. Change to "N" where applicable.
In Administration>Financial>Insurance Codes>Carrier Codes, enter the appropriate assigned payer/ID codes as assigned by Medi-Cal for each insurance carrier.
In Administration>Financial>Insurance Codes>General, complete the Provider Taxonomy Code field.
For the receiver ID, enter the Medi-Cal receiver ID of "610442" in Administration>Financial>Insurance Codes>EMC.
For payer's receiver name, enter "Medi-Cal" in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter your agency's 7-digit assigned Trading Partner ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
>
Suppress dots & dashes in ICD codes, dates and insured info.
>
Go to the Administration>Financial>Insurance Codes>Print Variations tab. Select the following print variations. All other locators are standard.
Use Patient>General>Claim Constants to enter the patient's Waiver Identification Number.
Suppress printing of Patient Status Code (new Print Variation).
Suppress printing Value Code 44.
Use Patient>General>Claim Constants to enter other codes if applicable.
Billing Detail Locators 42-47 Rules for all Claims
Print total line on last line in revenue section.
- ► California Medi-Cal AIDS Waiver, 837I 5010A2 Electronic
-
Refer to the California Medi-Cal AIDS Waiver, UB-04 Hardcopy instructions for additional setup information.
For California Medi-Cal AIDS Waiver, 837I 5010A2 Electronic, define the following items:
>
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance.
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
>
Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
FL 31 (Unlabeled): In Patient>General>Claim Constants, enter one of the following delay reason codes and include the required documentation if there is an exception to the six-months-from-the-month-of-service billing.
Administrative delay in prior approval process (decision appeals)
If a patient has a 'Share of Cost' for procedures or services, then the FC value code is automatically generated for each claim with the Total Amount. The automatically generated FC value code can be overridden by entering a value code and Total Amount in Patient>General>Claim Constants.
Note: Ensure that the 23 value code with Spend Down amount is not entered for this claim period in Patient>General>Claim Constants.
The following fields in the application are required for California Medi-Cal AIDS Waiver, 837I 5010A2 Electronic.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Yby default for each carrier. Change to N where applicable.
Enter the appropriate payer or ID codes assigned by Medi-Cal for each insurance in Administration>Financial>Insurance Codes>Carrier Codes.
Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
Enter the Medi-Cal receiver ID of 610442 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Enter Medi-Cal in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter the agency's 7-digit trading partner ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.