WCIS eNews No. 102
April 1, 2014

Reporting Diagnosis codes for services after February 12, 2014

The Division of Workers’ Compensation’s electronic billing rules adopted the CMS1500 Health Insurance Claim Form Version 02/12 (CMS/1500) on February 12, 2014 . The effective date of the voluntary use of the form is February 12, 2014 through March 31, 2014, and the mandatory use date will be effective April 1, 2014. This form allows for reporting of up to 12 diagnosis codes and diagnosis pointers with character value A through L. California Division of Workers' Compensation Medical Billing and Payment Guide Version 1.2

Currently, for medical bill payment reporting, California’s Workers’ Compensation Information System (WCIS) has adopted, California EDI Implementation Guide for Medical Bill Payment Records Version 1.1 dated November 15, 2011. This is based on the IAIABC EDI Implementation Guide for Medical Bill Payment Records Release 1.1 dated July 1, 2009. This release only allows up to 4 diagnosis codes and up to 4 diagnosis pointers; the diagnosis pointers are the numeric values 1-4.

The Division of Workers’ Compensation is aware of this mismatch between the medical bill standards and the state WCIS reporting standards and is working with the IAIABC to get a resolution to this issue. While we hope to get this issue resolved as soon as possible, under Labor Code 138.6(c), California data collection must be compatible with the Electronic Data Interchange system of the International Association of Industrial Accident Boards and Commissions. An Issue Resolution Request (IRR)(IRR752MEDR1.1E ) has been drafted and posted on the IAIABC website for member comments to work toward a solution.

WCIS trading partner contacts:
Johnny Lee
email: jblee@dir.ca.gov
phone: 510-286-6772
fax: 510-286-6862
Trading partner letters A, I-L, S-V, Z

Elisema Cantu
email: ecantu@dir.ca.gov
phone: 510-286-6763
fax: 510-286-6862
Trading partner letters B, D-F, N, O, W-Y

Kenneth Kong
email: kkong@dir.ca.gov
phone: 510-286-6753
fax: 510-286-6862
Trading partner letters C, G, H, M, P-R

Antoinette Esqueda
email: aesqueda@dir.ca.gov
phone: 510-286-6773
fax: 510-286-6862
Medical reports technical contact

Contents of this bulletin do not change existing regulatory requirements; they provide additional or revised detail about the technical implementation of those requirements. All technical changes will subsequently be reflected in other WCIS documentation. Any bulletin can be forwarded as needed, but should be forwarded in its entirety and without modification. If you have received a forwarded copy of this bulletin and are concerned about its authenticity, you can view this and previous bulletins on our WCIS web site: http://www.dir.ca.gov/dwc/wcis.htm.

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