Essential updates for community services boards’ claims processing

We will implement updates to improve claims processing for community services boards (CSBs) on October 1, 2025. These changes aim to ensure accuracy and compliance with state guidelines. Ensure all billing practices reflect these changes. These updates have no impact on member services or experiences, ensuring seamless continuity of care.

Note the following requirements and updates:

• For professional claims submitted using the CMS‑1500 form, include the rendering practitioner’s information in boxes 24J and 31. This information is vital for proper claim handling and payment processing.
• Ensure the CSB’s NPI and taxonomy are included in the appropriate fields of box 33 on the CMS‑1500 claim form. Accurately entering these details is crucial for correct claims processing. CSBs are required to bill with taxonomy 251S00000X.
• Use place of service (POS) 53 except telehealth claims, which are required to use POS 02 or 10.
• Practitioners must secure enrollment with the Department of Medical Assistance Services (DMAS); however, they do not need to affiliate/link their practitioners to groups in the PRSS. We will ensure that all care providers listed on the claim are enrolled with DMAS to comply with state enrollment guidelines.