Radiology Billing Requirements: Effective June 1, 2019, providers will be required to identify professional and technical component using appropriate modifiers (“26” or “TC”) on radiology services. Radiology services include but are not limited to procedure codes ranging from 70000 through 79999. CHCN requires this information in order to process claims in accordance with contracted health plans’ Division of Financial Responsibility (DOFR). After June 1 2019, radiology procedures billed without a modifier will be adjusted “UDM9” instructing providers to bill with the appropriate modifier.
Also effective June 1, 2019, Alameda Alliance for Health is the appropriate payor for technical component of radiology services in all places of service (POS), including office setting (POS 11). After June 1, 2019, technical component of radiology procedures will be adjusted “UDB7” and providers will be instructed to bill the health plan. CHCN will forward claims received with technical component to the health plan. CHCN will continue to process technical component for radiology procedures for CHCN Anthem Blue Cross members in a place of service 11.
For exact CPT codes reference the Medi-Cal table at: http://files.medi-cal.ca.gov/pubsdoco/Rates/rates_range_display.asp.
Beginning April 1, 2019, Anthem Blue Cross will perform inpatient utilization reviews for hospitalized CHCN Anthem members. Please submit your request directly to Anthem Blue Cross at Fax: (866) 333-4826. To ensure your request has been processed, please contact Anthem Blue Cross at Phone: (888) 831-2246 option #3.
Authorization requests for outpatient services for CHCN Anthem members remain unchanged.
Requests for CHCN Alameda Alliance for Health (AAH) also remain unchanged.
CHCN will continue to process inpatient and prior authorization requests for CHCN AAH members.
CHCN has ‘Saturday’ nurse coverage to meet your Inpatient and Outpatient Utilization Management needs.
For assistance with Inpatient authorizations call (510) 314-4388. For assistance with Outpatient authorization call (510) 754-8873.
Please contact CHCN Utilization Management department at 510-297-0481 or firstname.lastname@example.org if you have any questions.
For portal related questions contact our Portal Support Team at email@example.com or 510-297-0480.