Provider Alerts

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Date:	December 15, 2016
To:	Health Plan of San Joaquin (HPSJ) Providers
From:	Claims Department
Subject:	California Children Services (CCS) Eligible Services
Business:	Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM)

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Health Plan of San Joaquin (HPSJ) strives to maintain, update and educate on the guidelines set forth by Medi-Cal (MCAL) while continually seeking ways to streamline processes. We believe the following will be helpful for your practice.

• Any CCS eligible service should be billed to CCS before the Managed Care Plan (MCP).
• As we continue to streamline our claims process to align with MCAL, you may see an increase in the denials you receive regarding possible CCS conditions.
  • If you receive denials you will need to bill CCS with a Service Authorization Request (SAR).
  • If the SAR is denied, or if you have a Notice of Action (NOA) on file, please resubmit to HPSJ as a corrected claim with a copy of the denied SAR or NOA.
  • For billing criteria pertaining to corrected claims, please refer to the previous Provider Alert dated April 20, 2016 (attached).
  • Please DO NOT submit a dispute with the SAR denial or NOA as this will delay processing of the claim.

For tips on billing CCS, please refer to the MCAL website http://www.medi-cal.ca.gov under one of these sections:

1. California Children’s Services (CCS) Program Eligibility
2. California Children’s Services (CCS) Program Service Code Groupings
3. CCS

If you have any further questions, please contact our Provider Services Department at 209-942-6340.

Attached: Provider Alert (ADVICE – Correcting CMS-1500 Claims Submissions / Also, when NOT to submit a dispute)