Provider Alerts

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To:	Primary Care Providers (PCP)
From:	Health Plan of San Joaquin Pharmacy and Therapeutics Committee
Subject:	CHDP PM 160 Changes to the Current Billing Process
Products:	Medi-Cal Managed Care
Effective:	June 30, 2015

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As a valued HPSJ provider, we want to make you aware of several coming billing changes. These changes are required by the California Department of Health Care Services (DHCS) and are being implemented in accordance with their requirements.

Effective June 30, 2015: Regardless of date of service (DOS) – 

• Brown/White CHDP PM 160 (capitated) forms must be used when submitting CHDP services. 
• Green/White CHDP PM 160 (fee-for-service) forms can no longer be accepted by HPSJ. 
• When billing CHDP services, along with the CHDP PM 160 form, you must also submit a CMS 1500 billing form or EDI 837 format. These services will be reimbursed at the CPT Code rates. 
• PM 160 yellow copy must continue to be sent to the local CHDP office. 
• DRE, our provider portal, will no longer be available to submit CHDP PM 160 forms electronically. 
• Good News – HPSJ will pay $9.00 on each immunization administered, instead of one flat fee for all children’s shots. 
• When billing immunizations, an administration fee must be billed for the number of immunizations administered in order to be reimbursed. Example: If billing for (3) administration fees, your billing would appear this way:

 

CHDP PM 160 Changes to the Current Billing Process (Continued) –

• CHDP PM 160s will not be accepted at HPSJ’s physical address, but must be submitted to the HPSJ P.O. Box address noted below.
• Regardless of dates of service (DOS), any CHDP services billed 6/30/15 or
  later will be required to submit PM 160 and CMS 1500 (or 837 EDI) claims
  submissions to the billing address noted below.
  
• Mail CHDP PM 160 forms and CMS 1500 billing forms directly to:
  Health Plan of San Joaquin
  P.O. Box 839
  El Cerrito, CA 94530
  
• If submitting an EDI in place of the CMS 1500 billing form, you can use
  either Office Ally or Emdeon, which are HPSJ’s preferred EDI vendors.

  Office Ally Payer ID: HPSJ1
  Phone: (866) 575-4120

  Emdeon Payer ID: 68035
  Phone: (866) 924-4634

REMINDER – For best results locating claims through DRE, you can search by using
the Member ID or Date of Service (DOS).

Please contact HPSJ Provider Services Representative Amanda Yang,
at (209) 469-8333, or ayang@hpsj.com:

• To create an account and access DRE
• If you require additional information regarding the EDI vendors
• If you have questions about this Alert