22-464 Respond to Requests for Itemized Bills to Ensure Timely Payment

Date: 06/10/22

This information applies to Hopsitals.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Avoid delays for hospital inpatient claims 

Providers must send itemized bills supporting inpatient claims as instructed when they are notified by fax, phone or mail. 

Pre-payment review

The Plan’s pre-payment review will ensure only correct billed charges, according to the Centers for Medicare & Medicaid Services Provider Reimbursement Manual, the Uniform Billing Editor guidelines and Revenue Code Definition requirements, are reimbursed. Plan policies will also be used in the review process.

These reviews will not be applicable where disallowed by provider contract.

Additional information

Providers are encouraged to access the provider portal 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.