ADP Business Scenarios

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