Posting Office Charges

1. Hills Physicians
2. United Health Care
3. Health Plan of San Joaquin
4. Medicare
5. Medi-cal CCS
6. Straight Medi-cal
7. Blue Cross
8. Cigna
9. Partnership health plan
10. Blue Shield PPO/EPO
11. California Health & Wellness
12. Dignity / Western Health Advantage
13. Tricare (PPO) / Health Net Medi-cal
14. Sutter Select / SHP / SIP / SutterMedicalGroup
15. Nivano
16. Imperial
17. River City
18. Aetna
19. HealthNet Sequoia
20. Prime Community
21. Common Rules/Coding tips

For Commonly asked questions please review the following article regarding Billing rules.

- Posting charges Step by step:

Locate the Workqueue list > Select "Charge Review" > Double click "SCC ALL RULES" > Filter the charges to your preference and double click the charge to begin > Fill out the Encounter detilas, diagnosis details, and Charges according to the insurance type, chart notes provided and services completed.

Next step is to click on "96427 SCC CPCA ALL RULES"

Filter all the charges by SVC Date and provider

Retrieve the Office Charges for the date of posting

P drive> OFFICE SUPERBILLS > YEAR > DATE

-When adding the Authorization which should be the "Claim info: " Please have the Authorization and the dates that the authorization is expired. Example: 97523212452 EXP 04-05-2026

-To Add a "REPORT ATTACHED" and/or any comment, Select the the CPT code being charged on Line1 > and Select the "Charge detail" tab .

(see the images attached below)

Check mark Medical Necessity

Procedure comments: Report attached.

In this section, we typically document the report attached and/or the identification of a newborn infant using the mother's ID.

1.Hills Physicians HMO/PPO/Medi-cal

• No Authorization is required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• (IF it is Hill's Physicians Medi-cal see the notes that follow)
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

2.United HealthCare

• Authorization sometimes required. (Verify on superbill)
• Always need a primary Care Physician.
• New consultation codes 99203 and below only.
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• If the only 2 congenital DX codes are either Q22.2 or Q22.8 downcode the echo to 93306.
• Always print claims and mail them with a report attached.

3.Health plan of San Joaquin

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99245, 99244, 99243)
• Only use Modifier 25 & 59 when required, do not use any other modifiers for HPSJ.
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

4.Medicare

• No Authorization is required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.

5.Medi-Cal CCS

• SAR# is always required (Auth always req.)
• Only add referring/PCP if the SAR# belongs to someone else, (the physician attached to the SAR), otherwise remove the referring provider if the servicing provider owns the SAR or if it is an 02 SAR.
• Old consultation codes (i.e. 99245, 99244, 99243)
• First 2 DX must be congenital, avoid using "Z" codes.
• Only use Modifier 25 when required, do not use any other modifiers for CCS.
• Check if a follow up is required.
• All CCS charges must be billed with the report attached.

6.Straight Medi-cal

• No Authorization is required.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99245, 99244, 99243).
• Only use Modifier 25 & 59 when required, do not use any other modifiers for Medi-cal.
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

7.Anthem Blue Cross PPO/ HMO / Medi-cal

• No Authorization is required for B.C. M-Cal, But ALWAYS check Aim for Auths If it is a PPO, HMO, and EPO plan.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• (IF it is BlueCross Medi-cal see the notes that follow).
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

8.Cigna

• No Authorization is required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• Need to print claims and send them with the report attached. ADD "REPORT ATTACHED" to line 1.

9.Partnership Health Plan

• Authorization is SOMETIMES required. Always verify.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99245, 99244, 99243)
• Only use Modifier 25 & 59 when required, do not use any other modifiers for Partnership.
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

10.Blue Shield PPO/EPO/HMO

• Authorization is SOMETIMES required. Always verify.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.

11.California Health and Wellness

• Authorization is not required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

12.Dignity / Western Health Advantage

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99245, 99244, 99243)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• Always print the claim, no need to attach the report.

13.Tricare (PPO) / Health Net Medi-cal

• Authorization is SOMETIMES required. Always verify.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required. / DON'T HAND WRITE ON THE CLAIMS - ONLY SIGNATURE.
• (IF it is HealthNet Medi-cal see the notes that follow)
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

14.Sutter Select / SHP / SIP / SMG group & (Gould)

• Authorization is only required for *Sutter Gould*
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• (Sutter select iD# starts with a "Y", Sutter health plus starts with an "M".)

15.Nivano

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

16.Imperial

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59)
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

17.River City

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99205, 99204, 99203)
• Only use Modifier 25 & 59 when required, do not use any other modifiers for River city.
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

18.Aetna

• Authorization is not required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59),
• Check if a follow up is required.
• (IF it is Aetna Medi-cal see the notes that follow).
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

19.HealthNet Sequoia

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• Old consultation codes (i.e. 99245, 99244, 99243)
• All appropriate modifiers required. (i.e. 25, 51, 59),
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

20.Prime Community

• Authorization is ALWAYS required.
• Always need a primary Care Physician.
• New consultation codes (i.e. 99205, 99204, 99203)
• All appropriate modifiers required. (i.e. 25, 51, 59),
• Check if a follow up is required.
• IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
• IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached

21.Common Rules and Coding tips:

- If there are no congenital diagnosis codes, it is important to remember to downcode the echocardiogram from 93303 + Dopplers to the single code 93306.

-Use The "Shift"+"F4" keys together to delete lines.

-When billing a for a Fetal visit, Confirm all of the following details before posting the charge:

**Always add the weeks of Gestation of pregnancy when billing any Fetal Echocardiogram**

-Cash Pay Visit: $500

99205 $150

93000 $82

93303 $150

93320 $ 50

93325 $50

IF the $500 payment was completed as a co-pay and the EKG was not completed. The total will still be rounded to $500. Use exact amounts only when Payment wasn't received on the DOS and only particular services were provided.

Posting SHASTA and GOLDEN VALLEY office charges:

-When posting the consultation, make sure to change "CVD" to "NO".

-Change consult for Shasta visits to $60.00 / For Golden valley $85.00.

-After submitting the claim, the $60 / $85 consultation charge will appear as a self-pay charge.

-Transfer the consultation charge to the correct account. Right click on the consultation code of 60 or 85 dollars. For Shasta send to Acct# 8358540 | For Golden Valley send to Acct# 12053746.

-Remember to invoice for Golden Valley consultation charges!

-Make sure to create an invoice for Shasta and fax it to: 530-245-9075

Be sure to always verify all WARNING messages before selecting submit and Accept.