Important Update: It looks like Medi-Cal has removed some of it's claim service line limitations as of July 21, 2014.  See http://files.medi-cal.ca.gov/pubsdoco/hipaa/articles/hipaanews_22630.asp for more information.  The remainder of this article is in it original form.

As can be seen on Medi-Cal’s web site, number 15 at the following link http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaaqa_4010_837ip.asp (Note: the content of this link has changed on Medi-Cal's site), Medi-Cal only supports 22 lines per claim for Institutional Claims.

15.  You stated that you are not going to support the increased line limits (999). How many lines are you going to support (for example, how many lines can we submit in an 837 transaction)? According to ADP and DMH, they will accept up to 50 service lines (2400 LX). Your slide number 54 states that Medi-Cal will only accept a maximum of six.Z

Currently, Medi-Cal supports the following number lines:

·         Inpatient: 22 (Institutional)

·         Outpatient: 22 (Institutional)

·         LTC: 1 (Institutional)

·         Vision: 6 (Professional)

·         Professional Medical: 6 (Professional)

Institutional claims with more than 22 lines will be rejected.  I’m guessing this is a carryover from the UB forms, the UB04 having 22 lines per page.  However, what we’re talking about here is not just having a continuation page, we’re talking a totally separate claim.  We’re also talking about electronic claims, i.e., 837 files.  While it looks like the standard support up to 999 lines, Medi-Cal still only accepts 22.  The limitation is even greater in other cases like professional claims, where Medi-Cal’s limit is 6 lines instead of the 50 allowed by the standard.

The HIS/Billing Systems I’ve seen do not contain provisions for splitting a claim at 22 lines.  Some health systems work very hard to roll up items by revenue code to the tightest level to try not to exceed Medi-Cal’s limitation.  Some even split claims by date of service.  While these might (but not always) work for inpatient claims, it doesn’t work for outpatient claims.  Often times billers will have to manually split these claims into separate claims with no more than 22 lines each – not a fun or efficient use of time.

Forefront Technologies, using its tool package, has created a utility to split claims containing more than 22 lines, in an 837 file, into separate claims containing no more than 22 claims.  It can even be modified to accommodate the 6 line limitation for professional claims.  For more information contact Forefront Technologies at Contact Us

Forefront Technologies has created other utilities like this for processing and manipulating claims to accommodate almost any need.  Forefront has also created utilities for 835 files to roll up zero pays into a single zero pay check, break claim level payments into line level payments, roll up Medi-Cal’s individual payments for each line item into a single payment for all line items on the claim, and more.

Related Articles:

• Splitting an 835 file into separate files for each NPI
• When HIPAA EDI Standard Transactions are not always Standard