2

November 1, 2004

Children’s Regional Integrated Service System

American Academy of
Pediatrics, CA Dist.
California Children’s
Hospital Association
CARE Parent Network
CCS Programs of
Alameda, Contra
Costa, Marin, Napa,
Sacramento, San
Francisco, San
Joaquin, San
Mateo, Santa
Clara, Santa Cruz,
Solano, Sonoma,
Stanislaus and Yolo
Cos.
Children’s Hospital
Oakland
Children’s Specialty
Care Coalition
Community Gatepath
Family Resource
Network of Alameda
County
Family Resource
Network of San
Joaquin County
Family Voices of
California
Lucile Packard
Children’s Hospital
Matrix Parent
Network and
Resource Center
Parents Helping

Parents

Peaks and Valleys
Santa Clara Valley
Health and Hospital
System
Support for Families
of Children with
Disabilities
Sutter Medical Center
UC Davis Medical Ctr.
UCSF Children’s
Hospital
/ April, 2008
Dear Colleagues:
We are writing to provide you with the attached guidelines for completion of the UB-04 for Emergency Medi-Cal claims. The CRISS Claims Work Group developed these guidelines in response to reports of problems in obtaining reimbursement for Emergency Medi-Cal.
The guidelines provide simple instructions for completing the UB-04, the form for billing for Emergency Medi-Cal claims. We also attach the section of state regulations defining a Medi-Cal “emergency medical condition” and the documentation required when billing for emergency services. As the guidelines note, the Medi-Cal Provider Manual details procedures for claims for emergency services. Providers should check and follow all procedures in the Manual for these claims. The links to these sources are below:
§  OBRA/IRCA Aid Codes and Definitions
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-MTP/Part1/obra_z01.doc
§  UB04 Completion: Inpatient Services
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-MTP/Part2/ubcompip_i00.doc
We hope you find the guidelines helpful. Please feel free to circulate the guidelines to your colleagues and to contact us if you have questions or comments. Contact CRISS Project Director Laurie A. Soman at 510-540-8293 or .
Sincerely,
CRISS Steering Committee
Erin Aaberg Givans, Children’s Specialty Care Coalition
Joan Crook, CARE Parent Network
Chris Dybdahl, Santa Cruz County CCS
Louis Girling, MD, Santa Clara County CCS
Al Goldberg, MD, Marin County CCS
Tara James, USCF Children’s Hospital
Gregory Janos, MD, Sutter Medical Center, Sacramento
Barbara Sheehy, Contra Costa County CCS
Linda Tung, Support for Families of Children with Disabilities
Attachments

CRISS c/o Laurie A. Soman, Center for the Vulnerable Child, Children’s Hospital Oakland, 747 – 52nd Street,

Oakland, CA 94609 Phone: 510-428-3885 x 2712 Fax: 510-601-3913 E-mail: