Reminder: DHCS Encounter Requirement – Discharge Hour
| Date: | April 09, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers and Facilities |
| Type: | Informational |
| Subject: | Reminder: DHCS Encounter Requirement – Discharge Hour |
| Business: | Medi-Cal Managed Care |
As part of Health Plan’s ongoing efforts to ensure accurate and compliant claims processing, we would like to remind providers of the importance of including a valid discharge hour on applicable claim submissions. This requirement supports accurate encounter reconciliation with the California Department of Health Care Services (DHCS).
Discharge Hour Entry Guidelines:
When submitting institutional claims (UB-04 or electronic equivalent), please follow these formatting rules-
- Enter the discharge hour in a 24-hour format (00 to 23).
- Example: A discharge at 3:00 p.m. should be entered as 15.
- Do not include minutes—only the hour is required.
- If the patient has not yet been discharged, leave the discharge hour field blank.
- Do not enter “99”—this is considered an invalid value and will result in claim denial.
Correcting Denied Claims:
If a claim is denied due to a missing or invalid discharge hour, please resubmit the corrected claim using the appropriate Corrected Claim Process to ensure proper adjudication.
This requirement is in accordance with the DHCS Encounter Data Submission Requirements, as outlined in DHCS’APL 14-019 and UB-04 billing guidelines:
APL 14-019: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2014/APL14-019.pdf
We appreciate your attention to this matter and your commitment to maintaining the accuracy and integrity of our claims submissions. Thank you for your continued partnership and cooperation.
Thank you in advance for your continued collaboration.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
