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22-303m How to Help Your Paper Facility Claims Process Faster

Date: 04/14/22

This information applies to Participating Physician Groups (PPGs) and Hospitals.

Tips on filling out paper facility claims, updates to timely filing, and balance billing for screening and testing fees for COVID-19

This update has information about filling out certain areas of a paper facility claim, accessing the provider library, and answers to claim requirements for services given during the COVID-19 pandemic.

Reminders: Change alignment and check for missing or incorrect information on UB-04 forms

  • Box 1 – Left align the complete provider name and mailing address in this field. This keeps the data from shifting left when the optical character recognition (OCR) reader tries to align the data to the form.
  • Boxes 12–17:
    • Inpatient claims – Boxes 12–15 and box 17 should be completed. For post-discharge claims, box 16 is also required.
    • Outpatient claims – Boxes 14, 15 and 17 should be completed. Boxes 12, 13 and 16 should be left blank.

Exceptions: Type of bill codes 012x, 022x, 032x, 034x, 081x, and 082x require boxes 12 and 13 to be populated.

  

Find more information in the Provider Library. Select Medi-Cal > Provider Manual > Claims and Provider Reimbursement > Billing and Submission > UB-04 Billing Instructions.

Go online for updates about COVID-19

In response to frequently asked questions about timely filing, balance billing and the Medi-Cal appeals process during COVID-19, current information is provided below. This information can be found at provider.healthnet.com> COVID-19 Updates > Health Net Alerts under the section for COVID-19 General Information > COVID-19 Testing and Screening, Billing and Treatment Information.

What is the deadline to file claims?

For providers impacted by COVID-19, the deadline to file claims with dates of service:

  • March 5, 2020, through December 31, 2021, Medi-Cal claims will be extended for 90 calendar days beyond standard filing timelines or the timeline in your Provider Participation Agreement (PPA). This also applies to
    Medi-Cal late filing penalties.
  • Beginning with January 1, 2022, Medi-Cal claims will follow the standard filing timelines or the timeline in your PPA will apply.

Can providers balance bill members for fees related to screening and testing for COVID-19?

  • No, balance billing is strictly prohibited by state and federal law and your PPA.
  • Providers may not bill members for any fees related to screening and testing for COVID-19.

More information can be found in the Provider Library. Select Medi-Cal > Provider Manual > Claims and Provider Reimbursement > Balance Billing.

Are there changes to the appeal process for Medi-Cal members during the public health emergency?

During the public health emergency (PHE):

  • When a member's appeal involves the termination, suspension or reduction of previously authorized services, the Plan must provide Aid Paid Pending (APP) when an appeal and state fair hearing is filed timely.
  • The Plan is not allowed to seek reimbursement or payment for the additional days of services furnished during this period.

Additional information

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library after logging in to the provider website > Provider Library under Quick Links, or go directly to provider library.

Providers are encouraged to access the provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.



Last Updated: 04/13/2022