CMISP Billing Information


Claims
Unless otherwise directed, providers submit bills on a Medi-Cal UB-04 or CMS-1500 (HCFA) claim form to:
 
CMISP ACCOUNTS PAYABLE UNIT
7001-A East Parkway, Suite 250
Sacramento, CA 95823
 
NOTE: IN ORDER TO EXPEDITE PAYMENT, ALL BILLINGS MUST INCLUDE AN ORIGINAL SIGNATURE AS WELL AS THE COUNTY MEDICAL RECORD NUMBER AND COUNTY AUTHORIZATION NUMBER.
 
Providers refer to their Medi-Cal Provider Manual, Medi-Cal Billing Instructions section for detailed claim preparation information.
 
General Billing Information
Some general billing information is provided below: 
• Authorization - Authorizations are generally for a period of 30 days.
• Payment - Is generally made within 60 days from receipt of a correct billing invoice with valid authorization.
• All non-emergency services require Medical Case Management prior authorization.
• Tracers - Please wait at least 90 days before sending in a tracer on your claim. After the 90 day period when you send a tracer, please sign with original signature and date, and stamp or write "TRACER" on the top of the claim.

Billing Codes
CMISP strives to be consistent with Medi-Cal procedures. Current Procedural Terminology (CPT) codes should be used for medicine, surgery, radiology, and pathology. Injection codes and the HCPCS codes for support services are unchanged. Services rendered must be billed using the correct CPT codes with Medi-Cal modifiers (or with the HCPCs codes for DME and other support services).  Please include the National Drug Code (NDC) above CPT codes when drugs are being billed.
 
Automated Processing
Sacramento County has an automated CMISP claims process. The computer programs require the billing National Provider Identifier (NPI) number in order to process claims.
 
In addition to the billing NPI number, the applicable ICD-9-CM codes must also be present on your claims. The requested information follows the Medi-Cal billing procedures. Your cooperation in this matter helps us to expedite claims processing and keep your payments current. 
 
Reimbursement
Reimbursement rates and guidelines are consistent with the State’s program unless otherwise contractually negotiated. Claims for reimbursement are submitted to the CMISP Accounts Payable Unit.
 
Rejected Claims
Some of the most common reasons that claims may be rejected are:
     • Date billed does not match authorization date(s)
     • No referring physician name/number - when applicable
     • Patient Medical Record number is missing
     • Claim not signed with original signature
     • No authorization number is printed on claim
     • CPT codes billed do not match authorized codes
     • No modifier with CPT code – when applicable
     • No billing NPI number is given

Billing Questions
Please contact the appropriate unit in the CMISP Staff section below for any questions you may have regarding billed claims, authorizations, county invoices, eligibility or payments.

​Unit ​Address ​Phone
​Case Management ​9616 Micron Ave, Suite 670
Sacramento, CA 95827
​(916) 875-9843
(916) 875-9833 (fax)
​Provider Relations ​9616 Micron Ave, Suite 670
Sacramento, CA 95827
​(916) 876-5181
​Accounts Payable ​7001-A East Parkway, Suite 250
Sacramento, CA 95823
​(916) 875-9742
​Accounts Receivable ​7001-A East Parkway, Suite 250
Sacramento, CA 95823
​(916) 875-9743
​Eligibility ​4600 Broadway Suite 2600
Sacramento, CA 95820
​(916) 874-9238

 



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