Section 51502 - Billing Requirements(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.(b) Notwithstanding any other provisions of these regulations, payment for any service rendered includes the payment for completion of the required authorization or billing forms. No provider shall submit charges or receive additional payment for the completion of required authorization or billing forms.(c) All claims for services rendered in an organized outpatient clinic shall be submitted by the clinic, except that claims for surgical procedures provided in licensed surgical clinics may be submitted separately by physicians and by clinics for services provided by each provider.(d) The Department may require additional documentation to determine the medical necessity of services before paying benefits under the Medi-Cal program.Cal. Code Regs. Tit. 22, § 51502
1. New section filed 9-30-71 as an emergency; designated effective 10-1-71 (Register 71, No. 40). Certificate of Compliance--Section 11422.1, Gov. Code, filed 1-25-72 (Register 72, No. 5).
2. Amendment filed 8-6-76; effective thirtieth day thereafter (Register 76, No. 32).
3. Amendment of subsection (c) filed 12-30-77; designated effective 2-1-78 (Register 77, No. 53).
4. Amendment of subsection (a) filed 10-24-79; effective thirtieth day thereafter (Register 79, No. 42).
5. Amendment of subsection (a) filed 2-1-80; effective thirtieth day thereafter (Register 80, No. 5).
6. New subsection (d) filed 3-30-81; effective thirtieth day thereafter (Register 81, No. 14).
7. Amendment of subsections (a)(2) and (c) filed 3-6-85; effective thirtieth day thereafter (Register 85, No. 10).
8. Amendment of subsection (a)(4) and amendment of NOTE filed 10-24-2000 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 10-24-2000 (Register 2000, No. 43). A Certificate of Compliance must be transmitted to OAL by 4-23-2001 or emergency language will be repealed by operation of law on the following day.
9. Editorial correction of HISTORY 8 (Register 2001, No. 14).
10. Amendment of subsection (a)(4) and amendment of NOTE refiled 4-4-2001 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 4-4-2001 (Register 2001, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-2-2001 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-4-2001 order, including further amendment of subsection (a)(4), transmitted to OAL 7-31-2001 and filed 9-5-2001 (Register 2001, No. 36). Note: Authority cited: Sections 14105, 14115 and 14124.5, Welfare and Institutions Code; and Section 78, Chapter 146, Statutes of 1999. Reference: Sections 14018.2, 14043.75, 14059, 14115, 14124.5, 14132 and 14133, Welfare and Institutions Code.
1. New section filed 9-30-71 as an emergency; designated effective 10-1-71 (Register 71, No. 40). Certificate of Compliance -Section 11422.1, Gov. Code, filed 1-25-72 (Register 72, No. 5).
2. Amendment filed 8-6-76; effective thirtieth day thereafter (Register 76, No. 32).
3. Amendment of subsection (c) filed 12-30-77; designated effective 2-1-78 (Register 77, No. 53).
4. Amendment of subsection (a) filed 10-24-79; effective thirtieth day thereafter (Register 79, No. 42).
5. Amendment of subsection (a) filed 2-1-80; effective thirtieth day thereafter (Register 80, No. 5).
6. New subsection (d) filed 3-30-81; effective thirtieth day thereafter (Register 81, No. 14).
7. Amendment of subsections (a)(2) and (c) filed 3-6-85; effective thirtieth day thereafter (Register 85, No. 10).
8. Amendment of subsection (a)(4) and amendment of Note filed 10-24-2000 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 10-24-2000 (Register 2000, No. 43). A Certificate of Compliance must be transmitted to OAL by 4-23-2001 or emergency language will be repealed by operation of law on the following day.
9. Editorial correction of History 8 (Register 2001, No. 14).
10. Amendment of subsection (a)(4) and amendment of Note refiled 4-4-2001 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 4-4-2001 (Register 2001, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-2-2001 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-4-2001 order, including further amendment of subsection (a)(4), transmitted to OAL 7-31-2001 and filed 9-5-2001 (Register 2001, No. 36).