AMENDED ALERT – CHDP PM 160 Changes to Current Billing Process

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To: Primary Care Providers (PCP)
From: Health Plan of San Joaquin (HPSJ)
Subject: AMENDED ALERT – CHDP PM 160 Changes to Current Billing Process
Product: Medi-Cal Managed Care

As a valued HPSJ provider, we want to make you aware of several billing changes. These changes are required by Department of Health Care Services and have been implemented in accordance with their requirements.

April 1, 2015:

  • Brown/White CHDP PM 160 forms must be used when submitting CHDP services.
  • Green/White FFS CHDP PM 160 forms will no longer be accepted by HPSJ.
  • When billing CHDP services, you must also submit a CMS 1500 billing form or EDI 837 format. Use the correct modifiers when necessary.
  • CHDP PM 160s are no longer accepted through the provider portal, Doctor’s Referral Express (DRE).
  • When billing immunizations, an administration fee must be billed.
  • CHDP PM 160s will not be accepted at HPSJ’s physical address.
  • Mail CHDP PM 160 forms and CMS 1500 billing forms to:

Health Plan of San Joaquin
P.O. Box 839
El Cerrito, CA 94530

Reminder! For best results locating claims through DRE, our secure provider portal, search using the Member ID or Date of Service.
To create an account and access our secure provider portal, contact Amanda Yang (209) 469-8333, our Provider Services Representative.

If you have any questions regarding this alert, please call our Provider Services Department at (209)942-6340 or Amanda at the phone number noted above.

Posted on February 18th, 2015 and last modified on July 27th, 2015.