Claims And Eligibility

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Questions




If you have questions or need assistance, call our Provider Relations Department at:

1-714-246-8600

Monday through Friday from 8 a.m. to 4 p.m. Pacific Time

Claim Billing Update: Local Modifier ZS Discontinued – Effective August 1, 2015

CalOptima and the Department of Health Care Services (DHCS) have discontinued the use of local modifier ZS for dates of service on or after August 1, 2015.

Modifier ZS previously designated both the professional (26) and technical components (TC) of a split-billable procedure on a claim. When billing for both the professional and technical components, a modifier is not required nor allowed. This change continues CalOptima’s compliance with HIPAA requirements and is aligned with the Centers for Medicare & Medicaid Services (CMS) guidelines.

Providers who continue to submit claims for split-billable procedures using local modifier ZS for dates of service on or after August 1, 2015 will receive a claim denial.

CalOptima Link

How to Reach Us

If you are a provider or other health care professional and have a question regarding the Medi-Cal, OneCare (HMO SNP), OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan), or PACE programs, please call our Provider Relations Department at 1-714-246-8600.

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