MEDI-CAL Claims

Claims

Claims

ICD-10

On July 31, 2014, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will require ICD-10 to be implemented on October 1, 2015, and that will require HIPAA-covered entities to continue to use ICD-9 until September 30, 2015. All HIPAA covered entities must be able to successfully submit transactions on or after October 1, 2015, using the ICD-10 diagnosis and procedure codes. Care1st is ready to accept ICD-10 for outpatient services on or after October 1, 2105 and inpatient dates of discharge on or after October 1, 2015.


CMS-1500 FORM CHANGES (VERSION 02/12)

The National Uniform Claim Committee (NUCC) revised and released the new version of CMS-1500 claim form (version 02/12). Medicare and Medi-Cal have already required the use of the new form version on April 1, 2014. Care1st will continue to accept old CMS-1500 form (version 08/05) until July 31, 2014.

Effective August 1, 2014, Care1st will no longer accept claims billed on the old CMS-1500 form (version 08/05).

The CMS-1500 form has been revised, in part, to align with the 5010 837P and accommodate future ICD-10 reporting. Most notable changes include:

  • Expansion of ICD/Diagnosis codes from 4 to 12
  • ICD field label and Indicators changed from numbers to letters
  • Diagnosis code pointers changed from numbers to letters
  • ICD indicator
  • Qualifiers to identify whether providers/physicians are ordering, referring or supervising role

To avoid delay in processing your claim, please ensure that applicable fields are filled out according to CMS-1500 form requirements. Ensure that diagnosis codes are entered in the correct fields. They must be entered in the alphabetical order and appropriate diagnosis code pointers are populated. ICD indicator field must also be filled out. Forms that are not properly completed will be rejected. For more information on how to complete CMS-1500 form version 02/12, visit www.nucc.org or www.medi-cal.ca.gov.

Additionally, Care1st encourages you to submit electronic claims to minimize delay on claims submission and mailing. You may contact and enroll with one of these clearinghouses: