News
PM 160 INF Forms to Sunset on January 1, 2019
Date: 07/31/18
Following the Department of Health Care Services (DHCS) phase out of the PM 160 Information Only (INF) form submission requirement for Child Health and Disability Prevention Program (CHDP) providers, the California Health & Wellness Plan (CHWP) will no longer accept PM 160 forms, effective January 1, 2019.
Providers are strongly urged to continue submitting the PM 160 forms to CHWP through the remainder of 2018 as an assurance that any Healthcare Effectiveness Data and Information Set (HEDIS®) quality information missing from encounter or claim data reporting is being captured. This data is used to report quality scores to regulatory agencies and also currently supplements primary care physician (PCP) and participating physician group (PPG) incentive programs.
It is important that all providers adopt CPT and ICD-10 codes in claims and encounter submissions to capture information typically submitted in a PM 160 form. To assist you in transitioning away from PM 160 forms, CHWP will be sending a reference guide in the following weeks that crosswalks the PM 160 fields to the appropriate CPT/ICD-10 codes. The crosswalk is also available on www.CAHealthWellness.com under Provider Resources > Manuals, Forms and Resources > More Resource Topics > Child Health and Disability Prevention (CHDP) Program > PM 160 INF Form Information > Billing for CHDP Services.
If training is needed, contact a local provider relations representative for assistance.
REMINDERS
All providers must submit claims or encounters for services rendered.
· CHDP providers must submit a CMS-1500 claim form to CHWP, or in the case of PPG-affiliated PCPs, a claim or encounter must be submitted to the PPG.
· All CHDP providers are encouraged (through the end of 2018) to submit a PM 160 form to CHWP, even if contracted with a PPG.
Order Paper Forms: To obtain more PM 160 INF forms, contact your county CHDP offices for as long as supplies last.
ADDITIONAL INFORMATION
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com 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 your Provider Relations representative or call 1-877-658-0305.