CCHP Network Providers: Important Changes to Billing
Transition from Medi-Cal Local Codes to National Codes (CPT -4 Level and HCPC Level II Codes)
We are notifying our providers on a major billing policy and change. Effective June 1, 2018 we will no longer be accepting any local codes, only National CPT 4 Level and HCPC Level codes. This directive comes from the Department of Health Care Services (DHCS) which will ensure that we are HIPPA complaint. In the past, the Medi-Cal Managed Care Plans (MCP) have used a variety of local codes to pay for health care services for our Medi-Cal members. Starting as early as 2015 DHCS has enforced the usage of Encounter Data Quality Measures to ensure the MCPs encounter data from the claims. Quality claims submission is the key to ensuring we are submitting quality encounter data to DHCS. Therefore it is imperative that we successfully transition to the National Codes for billing for services.
Using National Codes have several major advantages:
- Simplifies the process and is cost effective
- Enhances the efficiency and effectiveness of the health care system
- Decreases administrative burdens for providers
- Providers standardization for medical coding
It is our responsibility at CCHP to ensure that our providers bill accurately so we can reimburse our providers in a timely manner. When adjudicating claims we must ensure the claims is "clean" and has the prior authorizations for those services, the right National Provider Identifiers and the correct National CPT/HCPC codes.
In order to assist our providers we have reviewed our claims data and identified Local Codes and matched the National Codes. We will be publishing a Local to National Code Matrix to assist our provider in billing with the right National Codes. In addition, we will be hosting three training Webinars for our providers to attend the last two weeks in April.
We will post the training dates on the CCHP web portal by April 10th and we will send invitations to the Training. We encourage your billing staff or billing company attends one of these sessions.
Also, the DHCS website has some Frequently Asked Questions on the transition from local codes.
If you have any questions on this change please call our Claims Department at 1-877-800-7423, Option 5 and we will gladly assist you. If you have any major issues or concerns please contact our Chief Operations Officer at 925-313-6104 or submit an email to Sharron.Mackey@hsd.cccounty.us
We look forward to working with you as we transition from Local codes to National codes for health care services billing for Medi-Cal members in Contra Costa County.