News

20-318 Updated Guidance: To Avoid Claims Delays, Use the Correct Form to Bill Ancillary Services for American Indian Health Service Medi-Cal Claims

Date: 04/08/20

Tips to help you submit claims

Provider update 20-144, Use the Correct Form to Bill Ancillary Services for American Indian Health Service Medi-Cal Claims, had incorrectly advised providers to send all American Indian Health Service (IHS) Medi-Cal claims to California Health & Wellness Plan (CHWP). IHS providers should use the chart below to determine where to submit claims. The updated chart includes clarified instructions.

Use the correct form and billing address to avoid claims delays

For improved claims service, providers serving IHS Medi-Cal members are now required to use the CMS-1450 (UB-04) claim form instead of the CMS-1500 when submitting claims to CHWP for IHS Medi-Cal claims.

However, some specialty companies only accept the CMS-1500 form. Please refer to the following chart for correct forms and claims billing addresses for IHS claims.         

Entity responsible for claims	Form and additional instructions	Claims billing address
CHWP	UB-04 Submit all medical health visit (encounter) and ambulatory health visit (encounter) claims, excluding acupuncture services, to CHWP.	California Health & Wellness Attn: Claims PO Box 4080 Farmington, MO 63640-3835 CHWP payer ID 68047 for electronic claim submission
MHN	UB-04 Bill claims for behavioral health services with date of service April 1, 2020, and later to MHN.	MHN Attn: Claims PO Box 14621 Lexington, KY 40512-4621 MHN payer ID 22771 for electronic claim submission
CHWP	UB-04 Bill claims for behavioral health services with date of service prior to April 1, 2020, to CHWP.	California Health & Wellness Attn: Claims PO Box 4080 Farmington, MO 63640-3835 CHWP payer ID 68047 for electronic claim submission
American Specialty Health, Inc.	CMS-1500 Bill claims for acupuncture services to American Specialty Health, Inc. (ASH).	American Specialty Health Group, Inc. Claims Department PO Box 509001 San Diego, CA 92150-9001 Electronic claim submissions may be submitted via secure provider website ASHLink at www.ashlink.com
Envolve Vision	CMS-1500 Bill claims for vision services to Envolve Vision.	Envolve Vision PO Box 7548 Rocky Mount, NC 27804 Envolve Vision payer ID 56190 for electronic claim submission

 

Instructions for CHWP IHS Medi-Cal claims    

CHWP participating IHS program providers

Submit claims via the standard process and in accordance with the terms of the CHWP Provider Participation Agreement (PPA).

More information on claims submission and reimbursement is available online in the Provider Resources section of the provider website at www.CAHealthWellness.com.

Nonparticipating IHS program providers

Refer to the Provider Resources section of the provider website at www.CAHealthWellness.com to learn more about claims procedures and how to submit claims to CHWP.

For help with behavioral health questions

Providers may contact MHN at 1-800-647-7526 for behavioral health (BH) service referrals and general inquiries related to BH services, or visit the MHN website at www.mhn.com.

Providers may contact BH Provider Relations for most inquiries including contracting related inquiries, education and clinical training at MHN.ProviderServices@Healthnet.com.

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 at www.CAHealthWellness.com.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.