Billing Tips
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General Tips
• Corrections: Cover incorrect data using correction tape and re-enter the correct information. Do not strike over errors or use correction fluid.
• Avoid using dot matrix and light ink printers. The Alliance scans claims using Optical Character Recognition (OCR) software, which may not be able to interpret data from such printers.
• An original signature is required on all hardcopy claims. The signature must be written, not printed.
• Do not staple your hardcopy claims as it delays processing time.
• Pharmacy providers: When billing for metric quantity, use decimals.
• Before submitting your hardcopy claims, remove side perforations. Using side perforations delays claim processing time.
• Use appropriate fonts: 10 point font or larger (not to exceed the size of the field).
• Review monthly Medi-Cal bulletins for ongoing updates by going to www.medi-cal.ca.gov.
Billing Instructions
• Please reference the following tutorial for requirements and instructions on filling out the new CMS-1500 claim forms: CMS-1500 Claim Form
• Please reference the following tutorial for requirements and instructions on filling out the new UB-04 claim forms: UB-04 Claim Form
Medical Supplies:
Medical Supply Invoices
• Invoices cannot be older than 1 year from the date of service.
• Invoices must be dated prior to date of service billed.
• Any explanatory information added to the invoice by the provider to assist in the reimbursement process may only be handwritten. Typed information will result in the claim being denied.
• Catalogs or price lists must not be dated more than five years prior to the date of service.
• Include the catalog/price list front cover page indicating the type of catalog and price list used (manufacturer’s wholesale, dealer or distributor), as well as the catalog date.
Medical Supplies on Computer Media Claims (CMC)
• When billing medical supplies electronically, indicate the catalog name, item number and page number in the Comments section.
Durable Medical Equipment
• “By Report” DME Catalogs
• Claims that do not include all of the documentation listed below or are not submitted with a MSRP that was established prior to August 1, 2003 will be denied.
• Manufacturer’s purchase invoice or the MSRP dated prior to August 1, 2002
• Item description
• Manufacturer name
• Model number
• Catalog number
• If the claim includes items that were not available prior to August 1, 2003, the date of availability must be documented in the Reserved for Local Use area (Box 19) and providers must attach the initial catalog page(s) and MSRP(s) that list the item(s).
Internet Catalogs
• DME and medical supply catalogs obtained from the Internet are not acceptable. Claims submitted with pages from Web-based catalogs will be denied.