Linking Paper Attachments to POS Device Health Care Claims

Providers may link paper attachments to their 837 v.4010A1 Professional electronic health care claims submitted through the Point of Service (POS) device. The Department of Health Services (DHS) is introducing this new process to allow providers who submit electronic claims through the POS device to mail in their paper attachments.

To submit paper attachments linked to a POS device claim, providers must use an Attachment Control Form (ACF) as the coversheet for the supporting attachments. The ACF has a pre-printed Attachment Control Number (ACN), which providers input during their electronic claim submission in a specified field. Providers submit the electronic claim and mail the ACF along with the paper attachments to Medi-Cal. Medi-Cal then links the paper attachments and electronic claim for processing. Providers have a maximum of 40 calendar days after the electronic claim is submitted to mail the ACF along with the supporting documentation to Medi-Cal.

To begin using the new process, providers will need a supply of ACFs and ACF envelopes, which can be ordered by calling the Telephone Service Center (TSC) at 1-800-541-5555.