To obtain a national provider identifier (NPI) you may: All providers are required to submit claims and encounters using current HIPAA compliant codes, which include the standard CMS codes for ICD10, CPT, HCPCS, NDC and CDT, as appropriate.
Standard Code Sets as required by HIPAA are the codes used to identify specific diagnosis and clinical procedures on claims and encounter forms. To ensure timely claim processing, PHC California requires that adequate and appropriate documentation be submitted with each claim filed.ĭocumentation required with a CMS1500 or UB04 claim form:ĭoctor’s orders, nursing or therapy notesįull medical record with discharge summary We accept the revised CMS-1500 and UB-04 forms printed in Flint OCR Red, J6983, (or exact match) ink. Health Care Procedure Coding System (HCPC)ĬMS-1500 paper claim submissions must be submitted on form OMB-0938-0999(08-05) as noted on the document’s footer.International Classification of Diseases (ICD10-CM) for diagnostic coding.Current Procedural Terminology (CPT) for physician procedural terminology.Only current standard procedural terminology is acceptable for reimbursement per the following coding manuals: PHC California will process only legible claims received on the proper claim form that contains the essential data elements described above.
Name and state license number of rendering providerĬlaims that do not meet the criteria described above will be returned to the provider indicating the necessary information that is missing.Place of service or UB04 bill type code.Revenue, CPT, HCPCS code for service or item provided.All ICD10 diagnosis code(s) present upon visit.
The following information must be included on every claim: PHC California may deny any claim billed by the provider that is not received within the specified timely filing limit. The provider is responsible to submit all claims to PHC California within the specified timely filing limit. (By clicking on the link above, you will go to the Medi-Cal website which is operated by the California Department of Health Care Services and not PHC California.) Initial Claim SubmissionĬlaims for services provided to members assigned to PHC California must be submitted on the appropriate billing form (CMS1500, UB04, etc.) within ninety (90) calendar days, or as stated in the written service agreement with PHC California. PHC California is a Medi-Cal managed care plan and follows Medi-Cal fee schedules unless a differing reimbursement rate is contracted. Notification of this change was provided to all contracted providers in December 2020. Claims payment disputes, appeals, and supporting documentation such as copies of medical records, authorization forms, or other documents can be submitted to: If emailing an inquiry please do not include Patient Protected Health Information (PHI), but the best call back number or email to reach you. For claims inquiries please call the claims department at (888) 662-0626 or email Claims. For corrected claim submission(s) please review our Corrected Claim Guidelines. All claims from providers must be submitted to our clearing house Change Healthcare, submitting ID 95422. Starting JanuPHC California is no longer accepting paper claims.