Billing Errors_ Tips_ System Upd

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					CALIFORNIA CHILDREN’S
    SERVICES (CCS)
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
  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
ANY QUESTIONS?
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 2-01-06 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?

				
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