California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7 - Payment for Services and Supplies › Section 51502 - Billing Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 All charges submitted for payment shall be on billing forms approved by the
					 Director. Unless otherwise prescribed by the Director, the following shall be
					 included on or attached to each billing form:
(1) The name, address, and Medi-Cal provider
					 number of the provider submitting the billing.
(2) The name, address and Medi-Cal
					 identification number for the beneficiary receiving the services billed, MEDI
					 labels for services requiring this documentation and such other information as
					 the Director may prescribe to ensure correct payment of the claim.
(3) A coded description of each diagnosis, in
					 a form prescribed by the Director.
(4) A coded description of each procedure for
					 each service rendered to the beneficiary in a form prescribed by the Director.
					 The billing form for all clinical laboratory tests or examinations shall
					 include the diagnostic information specified in Section
					 51200(e).
(5) The Medi-Cal provider number or license
					 number, when different than the billing provider, for the following:
(A) The admitting, attending and operating
					 physician, dentist or podiatrist who provides hospital inpatient
					 services.
(B) The referring
					 physician, dentist, podiatrist and rendering practitioner who provides
					 outpatient institutional services, physician services and other provider
					 services.
(C) The attending
					 physician who renders services to a patient in a long-term care
					 facility.
(D) The ordering or
					 prescribing physician, dentist or podiatrist, when the service claimed by the
					 provider requires an order or prescription by a licensed practitioner as
					 defined by California law.
(E) The
					 facility where physician services or allied services were rendered if other
					 than home or office.
(6)
					 The Medi-Cal provider number or California laboratory identification number of
					 the laboratory where services were rendered for out-patient institutional
					 services, physician services and allied services.
(7) The total amount billed to Medicare and
					 the amount paid by Medicare for Medicare/Medi-Cal crossover claims for
					 long-term care services, hospital inpatient services, outpatient institutional
					 services, optometric services, physician services and allied
					 services.
(8) The number of pints
					 of blood and the Medicare blood deductible amount for Medicare/Medi-Cal
					 crossover claims for hospital inpatient services, outpatient and institutional
					 services, physician services and allied services.
(9) The Medicare deductible and coinsurance
					 amounts for Medicare/Medi-Cal crossover claims for long-term care services,
					 hospital inpatient services, outpatient institutional services, optometric
					 services, physician services and allied services.
(10) The charge for each service.
(11) The provider's signature certifying that
					 all information included on or attached to the billing form is true, accurate
					 and complete.