DHCS Encounter Requirements – Patient Reason DX
| Date: | July 16, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) All Providers & Facilities |
| From: | HPSJ Claims Department |
| Subject: | DHCS Encounter Requirements – Patient Reason DX |
| Business: | Medi-Cal |
As part of Health Plan of San Joaquin’s (HPSJ) continued efforts to ensure each claim submission will reconcile with each encounter submission to the California’s Department of Health Care Services (DHCS), HPSJ will be requiring a Patient Reason Diagnosis to be billed as of July 01, 2020, no matter the Date of Service.
The patient’s reason diagnosis code is required for all institutional claims with Bill Type (Box 04) 013X and 085X, Admission Type (Box 14) 1, 2, or 5 and Revenue Codes 045X, 0516 or 0762 are billed.
If a denial is received, a re-submission of the claim with the corrected/additional information is required using the Corrected Claim Process.
If you have questions, please contact our Customer Service Department at 209-942-6320.