1. Claim/Billing Updates

2. Baby Using Mom’s ID – Scenario 1 CCS issues a SAR to cover the newborn’s inpatient stay SAR is issued with CCS assigned CIN number Mom had Medi-Cal eligibility at time of delivery Provider submits claim using Mom’s ID Claim denies 9669 – CCS claim recipient does not match the SAR

3. Claim/Billing Updates Resolution Provider must rebill claim with the Mom’s ID Include in remarks field: Baby using Mom’s ID Claim will suspend at EDS for manual review Examiner will override edit Claim will adjudicate using Medi-Cal funds

4. Claim/Billing Updates Baby Using Mom’s ID – Scenario 2 CCS issues a SAR to cover the newborn’s inpatient stay SAR is issued with CCS assigned CIN number Newborn acquires Medi-Cal after SAR has been issued or; Mom had Medi-Cal eligibility at time of delivery Provider submits claim using newborn’s CIN number on SAR Claim adjudicates from CCS funds as opposed to Medi-Cal funds

5. Claim/Billing Updates Resolution Link newborn’s CCS CIN to Medi-Cal’s CIN through CMSNet Provider or County may complete and submit to EDS a Claims Inquiry Form (CIF) or an Appeal form requesting EDS to void original claim due to incorrect funding source Void claim and adjustments will appear on future MR910/940 reports Provider must submit a new claim with Mom’s ID or the newborn’s CIN that reflects Medi-Cal eligibility

6. Claim/Billing Updates CALPOS Update to Client Index Number (CIN) County/Regional office staff link the CCS CIN number to Medi-Cal’s CIN through CMSNet CMS Branch combines the CIN numbers in MEDS This transaction causes an update of CINs to existing SARs which is transparent to the Counties and Providers

7. Claim/Billing Updates CALPOS, continued CALPOS did not recognize the updated SARs Therefore, claims were erroneously denied to providers Problem was corrected January 12, 2005 Provider must rebill erroneously denied claims

8. Claim/Billing Updates CALPOS, continued SARs issued to Pharmacies were denying when multiple lines were billed on the same transaction through CALPOS Contact the Help Desk Problem statement submitted Resolution pending

9. Claim/Billing Updates CALPOS, continued Healthy Families claims erroneously denying again for Other Health Coverage (OHC) Pharmacy must rebill the claim and override the OHC edit Problem statement submitted Resolution pending

10. Claim/Billing Updates Prosthetics and Orthotics (P&O) P&O providers are receiving denials when a referring provider is not indicated on the claim form P&O providers are required to indicate a referring physician on the claim form even though the SAR is issued directly to the P&O provider Providers must rebill the claim indicating the referring providers nine digit Medi-cal provider number in box 17a or; Indicate the provider’s name in box 17 and their five digit state license number in box 17a

11. SAR Survey Considering combining New Referral SAR and Established SAR Contact your Regional office with your comments and concerns No later than February 7, 2005

12. Provider Training Provider trainings will begin in March 2005 Both instructor led and satellite trainings Information on trainings in future Medi-Cal bulletins and on Medi-Cal website. To access the website go to www.medi-cal.ca.gov. Click on the Provider Relations link for training information.www.medi-cal.ca.gov

13. Any Questions?