Billing and Reimbursement

What is the ‘900 code’ and why is it important? 

The 900 code is a unique indicator added to the Medi-Cal billing system after DHCS receives a valid Hospice Program Attestation form. Claims will be denied without this code.

How does Hospice Program Attestation Form submission impact reimbursement? 

No form = No 900 Code = No Payment. Late or missing forms result in denied claims.

What happens if I miss the five-day submission deadline? 

Late submissions are non-compliant and result in reimbursement only from the date the form is received.

What If the Hospice Election or Addendum forms are rejected?         

The Hospice Clerk will notify the Hospice agency of the necessary corrections as soon as possible. 

Where can I find the DHCS Hospice Program contact information?           

The DHCS Hospice Program web page has contacts, resources, and the latest updates. You can email your questions to MCHospiceClerk@DHCS.ca.gov or call (916) 552-9200.

What is the “5-Day Rule” for the attestation submission?

Hospice providers must submit the Attestation Form within five (5) calendar days of the member’s hospice election date:

• For FFS members: DHCS must receive the form within 5 days.
• For MC members: The MCP must receive the form within 5 days.

Late submissions are non-compliant and result in:

• Potential denial of payment for days before receipt.
• Reimbursement only from the date the form is received

Are there exceptions to the 5-day rule?

Yes. DHCS may allow exceptions in limited cases, such as:

• Natural disasters or emergencies: This includes fires, floods, earthquakes, or other events that disrupt operations.
• System or technical failures: DHCS system outages or email delivery failures that prevent timely submission.
• Newly certified hospice providers: DHCS system access not yet granted and/or delay in onboarding after certification.
• Retroactive Medi-Cal Eligibility: Hospice provider was not and could not have been reasonably aware that the Medi-Cal member was eligible for hospice services at the time of election. For this item, hospice providers must document and provide: Proof of retroactive eligibility;Valid hospice Attestation form;Certification of terminal illness; andAdministrative corrections, if any.

For any of the above exceptions, please note that DHCS will only accept late attestation forms when the delay is beyond the hospice provider’s control and the hospice provider’s actions or inactions did not otherwise contribute to or result in the delay. Absent an approved exception from DHCS, hospice services rendered under a late Medi-Cal Hospice Attestation form will not be eligible for any reimbursement. 

How do I know whether to send the form to DHCS or an MCP?

Check the member’s eligibility on the hospice election date using:

• MEDS (Medi-Cal Eligibility Data System)
• POS (Point of Service) system

Also check for retroactive MCP enrollment to avoid misrouting.

Does this new process apply to both Medi-Cal fee-for-service (FFS) and managed care members?

No. This new process only applies to Medi-Cal FFS members electing to receive hospice services.

Are NOEs required for dual-eligible Medi-Cal members?

Yes. Even if Medi-Cal is the secondary payer and Medicare is primary, a valid hospice NOE form is required to be on file for all Medi-Cal members (both FFS and managed care) electing to receive hospice services.

Do hospice providers need to submit a hospice Attestation Form for a dual-eligible Medicare/Medi-Cal member for which the hospice provider is only submitting room & board claims to DHCS or a Medi-Cal MCP for payment?

Yes. A valid hospice Attestation Form must be submitted and on file in order for DHCS or a Medi-Cal MCP to reimburse hospice providers for room and board claims.

What if the individual does not have Medi-Cal at admission but is approved retroactively?

Hospice providers are responsible for verifying Medi-Cal member eligibility prior to rendering and billing for hospice services. Additionally, hospice providers can contact the DHCS Hospice Clerk for further assistance at MCHospiceClerk@dhcs.ca.gov. Hospice providers will need to provide proof of retroactive eligibility and submit the Attestation Form within five (5) days of the Medi-Cal member’s election date.

How do hospice providers notify DHCS of a Medi-Cal member revocation of hospice services?

Hospice providers must submit notice of revocation for Medi-Cal FFS members only via email directly to the DHCS Hospice Clerk at MCHospiceClerk@dhcs.ca.gov. For Medi-Cal managed care members, hospice providers must submit that information directly to the Medi-Cal member’s assigned MCP. Please note that this is the current process.

Do hospice providers also need to notify DHCS regarding discharges and/or transfers?

Yes. Hospice providers must timely notify DHCS for Medi-Cal FFS members, or the assigned Medi-Cal MCP for Medi-Cal managed care members, relative to all discharges and/or transfers as well as the reason for the discharge and/or transfer (e.g., death or moving out of service area, etc.).

What if the Medi-Cal member revokes and later returns to hospice, do hospice providers need to submit a new hospice Attestation Form?

Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member revokes hospice but then later returns to hospice.

What if the Medi-Cal member transfers from another hospice, do hospice providers need to submit a new hospice Attestation Form?

Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member transfers from one hospice provider to another.

What if the Medi-Cal member does not have a diagnosis of a terminal illness at admission?

A physician’s certification of terminal illness is required before the hospice provider submits the hospice Attestation Form.

Is a placeholder diagnosis code acceptable?

No. A valid diagnosis code and physician’s certification of terminal illness is required.