Billing guidance for COVID-related services
Do you need to submit a claim to cover COVID-19-related services for an Alliance member, such as testing or follow up? Referral Authorization Form (RAF) requirements will be waived by following these instructions:
- Use the EMG indicator on box 24C or condition code 81 on the UB 04 form.
- CMS-1500, box 24C: Emergency Code: Enter an “X” when billing for emergency services (otherwise, the claim may be reduced or denied). Only one emergency indicator is allowed per claim and must be placed in the unshaded, bottom portion of box 24C.
- UB 04 form, boxes 18 through 28: Use condition code 81 to denote an emergent service.
- In the remarks box for both claim forms, include the statement, “Patient impacted by COVID-19” or similar notation.
For more information on the scope of COVID-related services and DHCS’ guidance, refer to Coverage of Emergency COVID-19 Inpatient or Outpatient Services.
Self-attest by July 1 to continue receiving payments for ACE screenings
Starting July 1, 2020, providers must attest to taking the “Becoming ACEs Aware in California” training in order to continue receiving payment for screening patients for ACEs. Attestation only takes a few minutes on the DHCS website.
More information about ACEs Aware training, attestation and payment for qualified screenings is available on the ACEs Aware blog.