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Medi-Cal Managed Care Claims and Encounter Data Reporting

Background

The National Provider Identifier (NPI) Final Rule, established in accordance with the Health Insurance Portability and Accountability Act (HIPAA) provisions, created the NPI as the standard unique identifier for health care providers.  This rule requires the use of the NPI on covered standard electronic transactions after the May 23, 2007 compliance date.

The DHCS must make major computer system changes to incorporate the NPI into our processes, databases and reports.  A significant impact to the MMCD, in particular, involves the reporting and processing of claims and encounter data.  DHCS has initiated efforts to update the claims and encounter data reporting formats submitted by the plans with HIPAA related field changes.

DHCS has completed work on claims and encounter data file layouts and associated documentation.  This information is provided below.

NPI related All Plan Letters (APLs):

  • 07-005 (PDF) - Issued 05/18/2007; "Implementation of NPI Update"
  • 06-006 (PDF) - Issued 09/08/2006; "NPI Update"
  • 06-004 (PDF) - Issued 06/14/2006; "National Provider Identifier (NPI)"

 

S-35C Reporting Information

 Helpful Links and Resources

Last modified on: 2/28/2014 2:28 PM