Claims Corner
CenCal HEALTH’s Claims Department posts updates to billing and benefit information for our Providers in our Claims Corner. These articles offer important and timely information that may affect how your claim is adjudicated.
Some of these updates may be changes to CenCal Health processes only, and some may be updates published by the State of California that apply to CenCal Health as well.
We recommend all of our Providers access these articles often. Any questions related to any of these articles may be directed to our Claims Department at (805) 562-1083.
Upcoming New Benefits
The following notifications have been identified as upcoming “New Benefits” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “New Benefits” notifications below.
| Attention | Notifications | Posting Date |
| ALL PROVIDERS | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Policy and Rate Changes
The following notifications have been identified as upcoming “Policy and/or Rate Changes” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Policy and/or Rate Changes” notifications below.
| Attention | Notifications | Posting Date |
| All Provider | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Diagnosis Restriction Changes
The following notifications have been identified as upcoming changes related to “Diagnosis Restrictions” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Diagnosis Restrictions” notifications below.
| Attention | Notificationst | Posting Date |
| All Providers | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Code Conversions
The following notifications have been identified as upcoming HIPAA-compliant “Code Conversions” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Code Conversion” notifications below.
| Attention | Notifications | Posting Date |
| Attention Notifications Posting Date LTC Providers |
COMING SOON — Effective for dates of service TBD — LTC local codes (01-98) will be terminated. Providers should bill using the appropriate HIPAA-compliant Revenue Codes. Please refer to the HIPAA section of our website for the latest conversion details. | July 2018 |
| Outpatient Hospitals | COMING SOON — Effective for dates of service TBD — local codes for Hospital Outpatient Services (Z7500-Z7514, Z7610-Z7614) will be terminated. Providers should bill using the appropriate HIPAA compliant, nationally recognized revenue codes, CPT-4 codes and/or HCPCS codes that best represents the service provided. Please refer to the HIPAA section of our website for the latest conversion information. | July 2018 |
| All Providers | Effective for dates of service on or after July 1, 2017 — CenCal Health will terminate ALL the local codes (X-codes & Z-codes). Providers should bill using the appropriate national CPT-4/HCPCS code, including the appropriate Revenue Code where applicable, that best represents the service provided. Please refer to the HIPAA section of our website for the latest conversion details. | June 2017 |