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ADP Business Scenarios

ADP Business Scenarios. Planned changes with 5010. No more PWK. Manual Override eliminated with 5010 No use for intended purpose Miscodings cause significant delays and workload Good Cause Certification will be retained for all Delay Reason Code use. Provider Identification.

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ADP Business Scenarios

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  1. ADP Business Scenarios Planned changes with 5010

  2. No more PWK • Manual Override eliminated with 5010 • No use for intended purpose • Miscodings cause significant delays and workload • Good Cause Certification will be retained for all Delay Reason Code use

  3. Provider Identification • County Operated or Direct Provider site • Service site identified as Billing Provider • No explicit Service Facility Location identified • County Contracted site • County identified as Billing Provider • Contracted service site identified as Service Facility Location

  4. Coordination of Benefits – Now • Billing Drug Medi-Cal (DMC) bypassing existing Other Health Coverage (OHC) • Some situations no COB information is required • Some situations billed as if denied, with OA/94 adjustment codes

  5. Coordination of Benefits – 5010 • Billing Drug Medi-Cal (DMC) bypassing existing Other Health Coverage (OHC) • All situations with existing OHC will require COB information in Loop 2320 • Situations allowing bypass of existing OHC use Loop 2320 COB Total Non-Covered Amount segment

  6. Replacement Timelines • Replacement claim that adds or modifies service lines – 6 months from first 835 for replaced claim • Replacement claim that only deletes service lines – 6 month limit does not apply

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