WHERE S THE MONEY Information Needed to

WHERE’S THE MONEY? !

Information Needed to Complete Claim Forms § Client’s 14 digit BIC # § Codes listed in SAR # § NPI # of referring physician § Effective dates authorized

For BIC card example see page E 2 of 2010 CCS Medi-Cal training book. Referring provider information SAR # NPI 9700001 NPI # Billing Information NPI

Client’s 14 digit BIC card # Billing Provider’s NPI SAR # Attending NPI & Name

Locating NPI Number of Referring Provider The referring provider name and NPI number are found on the SAR under the section titled “Provider Information. ” If still unable to locate another provider’s NPI number, please refer to the following website: https: //nppes. cms. hhs. gov/NPPES/NPIRegistry. Home. do Provider’s full legal name is needed.

Hints for Faster Payment Bill Electronically The California Medicaid Management Information System (CA-MMIS) immediately begins the edits & audits process and there are no delays in processing due to scanner issues or waiting for the input prep group. http: //files. medi-cal. ca. gov/pubsdoco/CTM_manual. asp

Hints for Faster Payment Billing electronically with attachments § Complete the Attachment Control Form (ACF) and mail or fax to ACS Services within 30 days. § Use the 11 -digit Attachment Control Number (ACN) from the ACF to populate the PWK segment of an 837 HIPAA transaction. § Indicate the method of transmission in the PWK segment.

Hints for Faster Payment § Use the colored envelopes (ie: blue & white). Colored envelopes are opened first. § Attach all undersized attachments to 8 X 11 white paper. Do NOT staple the attachments to the claim. § Do NOT send two sided documents. § Do NOT fold or crease claim forms.

Hints for Faster Payment § UPPER case letters – 10 point or larger for clarity. § Handwritten claim - BLACK ballpoint pen. § Do NOT use highlighters. § Do NOT use correction fluid or correction tape. § Use 9 digit zip code number that matches the billing address registered with your NPI.

Be sure to line up the printer & forms correctly.

What the Scanner Sees

SAR/CLAIM PROCESS Thank you! ? ? $$

January 29, 2011 November 30, 2010 Return RTD to: ACS PO Box 15200 Sacramento, CA 95851 -1200

How are you notified that there is a problem with your claim? R emittance A dvice D etail

Elm Street Hospital 13 Elm Street Sacramento, CA 95825 REED 987654321 D 5006 X 01 30303430190 10/15/05 X 40. 00 Return CIF to: ACS PO Box 15300 Sacramento, CA 95851 -1300 1. a 1. This iswas denied with code 0314. This CCSa CCS claim. is claim. 2. Claim 3. Claim was denied has CCS. 2. Attached POS showing recipientwith code 9664. 4. Please process as straight CCS. 3. Attached copy of SAR showing Dr’s NPI number. 4. Please reprocess.

Bull Oney Medical Clinic 123 ANY STREET Farside, CA 90006 Lewis, Toby 123456789 1. This is a CCS claim. 1. Claim was denied with code 0314. 2. This is a CCS claim. 3. Attached POS showing recipient has CCS. 2. Please process as denied with code Claim was straight CCS. 4. 0314. 3. Attached POE showing client has CCS. 4. Please reprocess as straight CCS. 9121717612301 02 01 06 010 9121717612302 987654321 D 5006 02 01 06 072 Return Appeal to: ACS PO Box 15300 Sacramento, CA 95851 -1300

RAD code 005 The number of units authorized on the SAR # has been exhausted. Tip § Compare the number of units entered on the claim with the number of units previously submitted and approved on the SAR #. § Request a new SAR if number of units have been exhausted.

RAD codes 002, 0314 & 9669 Client is not eligible. TIP § Verify the recipient’s ID number with a valid Medi-Cal Benefits Identification Card (BIC) PRIOR to rendering service, except in emergency. § Did the recipient have a Share of Cost (SOC)? If they did, have they already paid their SOC for that month? § Does the ID number on the claim match the ID number indicated on the SAR?

RAD codes 006, 9670, 9673 & 9662 The dates billed are not within the dates authorized on the SAR #. Tip § Check the dates on the SAR #. If they do not cover the time period for which you are billing, contact the local CCS office and request an extension of the existing SAR # or a new SAR #. § If you have received the SAR # from the Dr. or Hospital, double check with them to see if there has been a new SAR issued.

RAD code 9671 The services on the claim do not match the services authorized on SAR #. Tip Double check that the services being billed are contained within the Service Code Grouping or have been individually authorized on the SAR # you are billing under.

RAD code 9667 Restricted drug billed is not authorized by CCS. Tip § Restricted drugs are not billable with a SCG SAR. § Refer to part 2 of the Medi-Cal manual under Cal Child SAR page 6 for a list of drugs that require a separate SAR (these must be approved on the SAR with the provider’s number and the NDC listed on the SAR). § Verify that the hard copy SAR has the NDC listed and the pharmacy provider number listed.

CCS and Medi-Cal Share of Cost (SOC) § A client has no Medi-Cal benefit until SOC has been met. § Providers can choose to obligate the client’s SOC = Medi-Cal

CCS and Medi-Cal SOC If the provider has provided authorized services related to the CCS eligible condition and receives a denial stating that the client is not eligible for Medi-Cal benefits, the provider must: 1. Double check the Medi-Cal ID # is correct. 2. Double check that the client had Medi-Cal SOC for the dates of service. 3. Double check the SAR authorization. 4. File an appeal stating that: this is a CCS claim; claim was denied with code XXXX; attach copy of POE showing proof that recipient has CCS; and state that you need ACS to reprocess the claim as straight CCS.

CCS and Medi-Cal SOC Fresno County CCS will consider paying the client’s Medi. Cal Share of Cost if the following criteria are met: 1. The monthly CCS related medical charges are a minimum of 4 times the amount of the monthly SOC. 2. The client does not have any additional insurance coverage such as Healthy Families. 3. Date of Service is not more than 6 months from the date of the SOC request.

What is “Restricted Medi-Cal” aka “Emergency Medi-Cal”? An “emergency medical condition” is a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, which in the absence of immediate medical attention could reasonably be expected to result in any of the following: 1. Placing the patient’s health in serious jeopardy. 2. Serious impairment to bodily functions. 3. Serious dysfunction to any bodily organ or body part.

Emergency Medi-Cal If the client has Restricted Eligibility (aka Emergency Medi-Cal) AND the services provided are related to the CCS eligible condition, claims must be submitted as CCS-Only.

Over One Year Claims § If the request for authorization of services is submitted timely to the county but the county is unable to authorize the services within one year of the DOS, the resulting claims can be submitted to the local Fresno County office for override of the time limit. § The provider has 60 days from the date that the “problem” has been resolved to bill the claim.

Medi-Cal Crossover Claims § Claims for Medicare/Medi-Cal recipients must first be billed to the appropriate Medicare Administrative Contractor for processing of Medicare benefit. § Most approved Part A and Part B services billed to Medicare contractors cross over to Medi-Cal automatically. § On crossover claims, providers have 12 months from the month of service and 60 days from the Medicare Remittance Advice date to submit a crossover claim to Medi-Cal.

Additional information needed? Call Affiliated Computer Services (ACS) at 1 -800 -541 -5555 Have NPI # ready Get your Service Request # from ACS http: //files. medi-cal. ca. gov/pubsdoco/contact/services. asp#tsc Regional Rep for the Fresno/Madera area is Nicole Fellows. Nicole. Fellows@acs-inc. com.

Medi-Cal Learning Portal https: //learn. medi-cal. ca. gov/Home. aspx

Q U E S T I O N S THANK YOU FOR SERVING CCS CLIENTS!!! CMS Fiscal Unit (559) 600 -6518 Virginia Savalza – Account Clerk vsavalza@co. fresno. ca. us Sally Rector – Account Clerk srector@co. fresno. ca. us