HPSJ Member ID#

All claims billed for HPSJ members must be billed with their HPSJ member ID#. The ID# starts with 200.  Claims submitted with the MCL CIN# will be rejected as “member unknown.”  HPSJ member eligibility can be verified through the provider portal

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New born claims

Physician services for the care of the newborn child are covered under the mother’s benefits for the month of birth and the month following delivery. However, the newborn will have their own HPSJ Member ID number. The delivering facility must contact HPSJ with the baby face sheet so newborn can be set up in the system. The newborn ID number can be located through the provider portal when looking up the mother’s information. All claims for the newborn must be billed with the newborn ID number to receive payment.

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Billing for Non-Physician Practitioners

Per Medi–Cal Billing Guidelines (Provider Alert 06.15.16)
Reimbursement for services rendered by a nurse practitioner (NP) or Physician Assistant (PA) can be made only to the employing physician, organized outpatient clinic, or hospital outpatient department. No separate reimbursement is made for physician supervision of an NP/PA.

• The supervising physician’s provider number must be entered as the rendering physician’s on each applicable claim line.
• Do not identify the NP/PA as the rendering provider on the claim line.
• In the Remarks field (Box 19) of the CMS1500 form, include:
• The NP/PA name
• Provider number and type of credential

Medi-Cal Guidelines:

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Surgical Modifiers

Multiple Surgery Submissions (Provider Alert 10.12.16)

Medi-Cal has very specific Multiple Surgery Submissions guidelines.

All surgical procedure codes require a modifier. Failure to submit a modifier with a surgical procedure code will result in the claim being denied and returned to the provider for correction. The primary surgeon is required to use modifier AG on the only or highest valued surgical procedure code.

When multiple procedures are performed at the same operative session, providers are required to identify the major procedure with modifier AG — and each secondary, additional, or lesser procedures by adding modifier 51.  While Add-On codes and Modifier 51 Exempt codes are exempt from the multiple surgery reimbursement reduction, providers are still required to attach modifier 51 to each additional surgical procedure. Reference the Medi-Cal Guidelines at: http://www.medi-cal.ca.gov/ (See Surgery: Billing With Modifiers).

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If you feel that you or your billing department can benefit from Medi-Cal billing refresher training, visit the Medi-Cal website at https://learn.medi-cal.ca.gov/Training/ TrainingCalendar.aspx to sign up for seminars and/or e-learning courses.