New claim format for Child Health and Disability Prevention Program providers

October 09, 2017
Area(s) of Interest: Public Health Vaccination 

Historically, fee-for-service Child Health and Disability Prevention (CHDP) program health assessments and immunizations were billed by providers using the proprietary PM 160 claim form or its electronic equivalent. 

However, because this claim form applied local codes for the purpose of billing, it did not conform to federal HIPAA laws. In order to comply with HIPAA requirements, the California Department of Health Care Services (DHCS) stopped accepting PM 160 claim forms on July 1, 2017, except for claims with dates of service prior to July 1, 2017. Fee-for-service CHDP claims are now submitted using the claim forms utilized and accepted by the fee-for-service Medi-Cal system (i.e., CMS 1500 or UB-O4 claim forms, 837 P/I electronic transaction).

DHCS informed CHDP providers of this change through various communications. Important information and continuing updates are available on the Medi-Cal website (see below). Providers may submit questions or concerns regarding the CHDP code conversion and claim form transition to CHDPTransition@conduent.com.

More information is available in these resources:

  • CHDP Frequently Asked Questions
  • June 2017 Update: CHDP Program Code Conversion
  • CHDP Phase 2: Transition Billing Tips: Sept 13, 2017

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