CALIFORNIA CHILDREN’S SERVICES (CCS)

COMMON PROVIDER BILLING ERRORS AND HELPFUL BILLING TIPS

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error A claim from a physician for inpatient services is billed using the Service Authorization Request (SAR) issued to the hospital. Billing Tip Physicians must use the SAR issued for physician services. SARs issued to inpatient hospitals cover only the inpatient days and are restricted to use by inpatient providers.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The services on the claim do not match the services authorized on the SAR. Billing Tip The service billed must either be individually authorized on the SAR or contained within the Service Code Grouping (SCG) identified on the approved SAR.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The modifier on the claim used to bill for DME does not match the modifier on the SAR. Billing Tip The modifier used to bill for the DME must match the modifier on the SAR. If after obtaining a SAR it is determined that an incorrect DME modifier was requested or authorized, the provider must obtain a modified SAR adding in the original code with the correct modifier.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The provider number submitted on the claim is not the provider number used to obtain the SAR.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Tip When a SAR authorized to a physician is used for reimbursement by other providers from whom the physician has requested services, the other providers must indicate themselves as the rendering provider and the authorized physician’s Medi-Cal number as the referring provider. Note: This does not apply to Special Care Center SARs.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The CCS client’s ID number on the claim does not match the client number indicated on the SAR. Billing Tip With the exception of newborn babies using the mother’s ID number for the month of birth and/or the following month, the ID number submitted on the claim must match the ID number indicated on the SAR.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The number of units authorized on the SAR has been exhausted. These claims will most likely deny for RAD code 005, which indicates the service requires prior authorization. Billing Tip Compare the number of units entered on the claim with the number of units previously submitted and approved on the SAR.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS Billing Error The dates billed are not within the dates authorized on the SAR. The claim will most likely deny for RAD code 006, which indicates the dates billed are not within the authorized time period. Billing Tip Check the dates on the SAR. If they do not cover the time period for which you are billing, contact the appropriate CCS county or regional office.

COMMON BILLING ERRORS AND HELPFUL BILLING TIPS  Billing Error Claims authorized with a SAR should not be sent to the County, if provider sends to you do NOT send to EDS or Delta, Billing Tip send back to the provider with a note telling them to send directly to the FI and not you

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CALIFORNIA CHILDREN’S SERVICES (CCS) SYSTEM UPDATES

UPDATES SAR Modifications Ability to print a cancelled SAR Added addresses to carbon copy Added a Non PMF Panel tab Added the SAR # to the NOA Removed number of day limitation (allowing SARs # of days greater then 365)

UPDATES  SAR Modifications, continued Exclusion of Modifiers Y1, Y2, Y6 & Y7 Medical Home field displays on SAR Added additional special instructions Added the calendar date picker Removed the radio button from service codes

UPDATES Added SCG 09 - Chronic Dialysis Clinic authorized to provider types 42 (Chronic Dialysis Clinics) 15 (Community Hospital Outpatient) 61 (County Hospital Outpatient) and Special Care Centers (SCC) Note: Also provider type 42 (Chronic Dialysis Clinics) can be authorized with SCG 01

UPDATES Added SCG 08 – Federally Qualified Health Clinics (FQHC) & Rural Health Clinics (RHC) For use in issuing SARs to FQHCs or RHCs when the provider at one of these clinics is serving in conjunction with a CCS authorized Special Care Center or authorized specialist/sub-specialist. Will soon be available for Indian Health Clinics.

UPDATES EPSDT Negotiated Prices on SARs: Modified the security to allow users with SAR override or SAR EPSDT authority to authorize SARs with a procedure code with no price on file.

UPDATES New provider types B, G and U to the Delta Dental Provider Master File B = Billing Provider of an individual practice G = Billing Provider of an individual practice or group practice U = University Provider

UPDATES  Effective February 1, 2006, CCS claims for dates of service on or after submitted with CGP prefix provider numbers to county CCS programs or State Regional Offices for processing should be returned to the provider.  The provider should be advised to resubmit the claims using a valid Medi-Cal provider number.

UPDATES CMS Description for the Medical Supply Group: SARs and any other related correspondence will now display the CMS description instead of the service description.

UPDATES Provider Management – SCC Bulletin Modified the system to display the SCC team members in order of Medical Director first and then group team members alphabetically by specialty groups.

ANY QUESTIONS?