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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

22-302m How to Help Your Paper Facility Claims Process Faster

Date: 04/14/22

Tips on filling out paper facility claims, updates to timely filing, and balance billing for screening and testing fees for COVID-19

This update has information about filling out certain areas of a paper facility claim, accessing the provider manual, and answers to claim requirements for services given during the COVID-19 pandemic.

Reminders: Change alignment and check for missing or incorrect information on UB-04 claim forms

  • Box 1 – Left align the complete provider name and mailing address in this field. This keeps the data from shifting left when the optical character recognition (OCR) reader tries to align the data to the form.
  • Boxes 12–17:
    • Inpatient claims – Boxes 12–15 and box 17 should be completed. For post-discharge claims, box 16 is also required.
    • Outpatient claims – Boxes 14, 15 and 17 should be completed. Boxes 12, 13 and 16 should be left blank.

Exceptions: Type of bill codes 012x, 022x, 032x, 034x, 081x, and 082x require boxes 12 and 13 to be populated.

Find more information in the California Health & Wellness Plan’s (CHWP’s) provider manual. Go to Appendix VI: Claims Form Instructions and scroll to UB-04 Claim Form starting on page 275.

Go online for updates about COVID-19

In response to frequently asked questions about timely filing, balance billing and the Medi-Cal appeals process during COVID-19, current information is provided below. This information can be found at www.cahealthwellness.com/providers/important-updates.html under the section for COVID-19 General Information > COVID-19 Testing and Screening, Billing and Treatment Information.

What is the deadline to file claims?

For providers impacted by COVID-19, the deadline to file claims with dates of service:

  • March 5, 2020, through December 31, 2021, Medi-Cal claims will be extended for 90 calendar days beyond standard filing timelines or the timeline in your CHWP Provider Participation Agreement (PPA). This also applies to Medi-Cal late filing penalties.
  • Beginning with January 1, 2022, Medi-Cal claims will follow the standard filing timelines or the timeline in your CHWP PPA will apply.

Can providers balance bill members for fees related to screening and testing for COVID-19?

  • No, balance billing is strictly prohibited by state and federal law and CHWP's PPA.
  • Providers may not bill members for any fees related to screening and testing for COVID-19.

Are there changes to the appeal process for Medi-Cal members during the public health emergency?

During the public health emergency (PHE):

  • When a member's appeal involves the termination, suspension, or reduction of previously authorized services, CHWP must provide Aid Paid Pending (APP) when an appeal and state fair hearing is filed timely.
  • CHWP is not allowed to seek reimbursement or payment for the additional days of services furnished during this period.

Additional information

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. The provider operations manual is available in the Provider Resources section of the provider website. 

Providers are encouraged to access CHWP’s provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.