DHCS Encounter Requirements – Claim submissions
| Date: | July 16, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) All Providers & Facilities |
| From: | HPSJ Claims Department |
| Subject: | DHCS Encounter Requirements – Claim submissions |
| Business: | Medi-Cal |
As part of Health Plan of San Joaquin’s (HPSJ) continued efforts to ensure each claim submission will reconcile with each encounter submission to the California’s Department of Health Care Services (DHCS), HPSJ will be implementing several new claim denials this upcoming fiscal year (FY20/21) if claims are not submitted with the required information.
If a denial is received, a re-submission of the claim with the corrected/additional information is required using the Corrected Claim Process.
A few examples of upcoming denials:
- Admitting diagnosis code is required on inpatient claim
- Duplicate diagnosis code billed
- Missing a valid patient reason for visit diagnosis billing code
- Missing/incomplete/invalid patient’s address
- Operating physician missing from claim
The denials HPSJ has already implemented included:
- NDC Required
- Ambulance Pick-Up and Drop-Off location required
- Authorization number submitted on claim when required
As we start implementing the new denials, additional provider alert will follow with more detailed information. If you have questions, please contact our Customer Service Department at 209-942-6320.