22-575 Avoid Denials and Include Inpatient Discharge Hour on Final Claims

Date: 07/26/22

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

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.

Discharge value on a claim requires the discharge hour

As of July 6, 2022, the discharge hour (DHR) is mandatory for inpatient 837I encounters when the CL103 value (Patient Status Code) indicates the patient was discharged. If your claim was rejected for missing the DHR, resubmit the claim with the missing information.

This requirement was issued from the Department of Health Care Services (DHCS) and applies to all capitated or fee-for-service entities.

Values reported in CL103 and type of bill

The DHR is required when:

• One of the following values is reported in CL103:
  • 01, 02, 03, 04, 05, 06, 07, 09, 20, 21, 40, 41, 42, 43, 50, 51, 61, 62, 63, 64, 65, 66, 69, 70, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95.

and

• The last digit of the Type of Bill frequency code is one of the following:
  • xx1 – Admit through discharge.
  • xx4 – Last claim.
  • xx7 – Replacement of prior claim when the replacement is for a prior final claim.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by phone or through the Health Net* provider website.