Central California  Alliance For Health

 

Billing Tips

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General Tips

• Cover incorrect data using correction tape and re-enter the correct information.
   Do not strike over errors or use correction fluid.

• Avoid using light ink printers. The Alliance scans claims using Optical Character
   Recognition (OCR) software, which may not be able to interpret
   this data.

• An original signature is required on all hardcopy claims. The signature must be
   written, not printed.

• Do not staple hard copy claims as it delays processing time.

• Pharmacy providers should use decimals when billing for metric quantity.

• Before submitting hardcopy claims, remove side perforations as they delay
   claim processing time.

• Use 10 point font or larger (not to exceed the size of the field).

• Review monthly Medi-Cal bulletins for ongoing updates.


Billing Instructions


• Please reference the following tutorial for requirements and instructions on
   filling out CMS-1500 claim forms: CMS-1500 Claim Form

• Please reference the following tutorial for requirements and instructions on
   filling out UB-04 claim forms: UB-04 Claim Form

• CCS Billing & Payment:

   The Alliance will receive and process claims for all CCS-eligible Medi-Cal members
   with dates of service on or after July 1, 2018. Please submit claims with dates of
   service prior to July 1, 2018 to the state for reimbursement.

   – If you have questions, please call the Alliance Claims department at
     (800) 700-3874 ext. 5503.

   – The CCS diagnosis code should only be listed on claims when treating
      the CCS condition.

   – SAR/TAR or authorization referral numbers are required to be included on
      CCS claims.


For additional CCS WCM information and resources, please visit the Whole Child Model page.



Claims Policies

600-1001 – Claims Processing
600-1006 – Breast Pumps and Coordination of Benefits
600-1007 – DME Rent-To-Purchase Pricing
600-1009 – Corrected Claim Submissions
600-1010 – Miscellaneous Drugs and Medical Supplies
600-1011 - Surgical Implantable Devices Billed with HCPCS Z7610, Miscellaneous Drugs and Medical Supplies Administered
600-1013 - Billing Epidural, Subarachnoid, and Nerve Block Injections for Postoperative Pain Management
600-1015 - National Correct Coding Initiative
600-1016 - Non-Covered Service Billed with GY Modifier to Medicare
600-1018 - Modifier Placement
600-1019 - Modifier 99 (Multiple Modifiers - Not recognized)
600-1022 - Charpentier Billing Procedure
600-1024 - Durable Medical Equipment Pricing
600-1026 - Incontinence and Medical Supply Pricing
600-1029 - Orthotics and Prosthetics Pricing
600-1030 - Reimbursement for Medicare/Medi-Cal Crossover Nephrology and Dialysis Services
600-1031 - Twins Delivery Reimbursement
600-1032 - Wheelchair/Scooter Repair Mileage and Medicare Denials
600-1033 - Wheelchair, Wheelchair Accessories and/or Replacement Parts for Patient-Owned Equipment Pricing
600-1034 - Slings (A4565) Reimbursement
600-1036 - Modifier Reference Grid
600-1037 - Global Surgery
600-1039 – Billing for Time-Based Anesthesia Services
600-1040 – Unbundled ENT CPT Codes
600-1041 – Medicare and Coordination of Benefits Reimbursement
600-1044 – H0049 and G0442 CHDP Program Reimbursement for Alcohol Misuse Screening
600-1072 -– AB 72

 

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