Medical Billing - CA1 Record

By: Michael Russell

There are quite a few special cases when doing medical billing. In this article, we're going to review one of these special cases, which is electronically billed using a CA1 record. This record is actually part of the patient records beginning with CA0, but is a special case that is medically billed only for Indian Health Services and only for Native American Indians. To understand billing using this record, one first needs to understand a little of the history behind it.

The Indian Health Service was actually started on July 1, 1955. The service was actually a transfer of power from the Bureau of Indian Affairs (BIA) to the Public Health Service (PHS). Not a lot was made of this at first, but as time went on, within 20 years, a number of publications started to come out regarding this service. Over time, hospitals were set up specifically to treat Native American Indians, starting with Northern Alaska.

While nobody has actually come right out and said it, it is believed that the reason this service was created was to somewhat make up for the acts of the United States government in removing the Native American Indians from their land. Certainly, there are those who believe that these people were owed at least this much. We're not taking any political stand in either. Simply stating facts and some speculation.

In any case, this CA1 record is required to be sent whenever a Native American Indian is treated by a physician or other provider and a bill needs to be sent to an insurance carrier. What follows are the very few specifications for that record.

CA1 field 1, positions 1 - 3, is the record type and must be filled in with CA1 or the claim will be denied.

CA1 field 2, positions 4 - 5, is reserved for future use. This is another one of those fields that has been reserved since the beginning of NSF specs and it is doubtful that it will ever be used.

CA1 field 3, positions 6 - 22, is the patient ID number. It is very important that this number also match the patient ID number from the CA0 record. Even though this is a claim for a Native American Indian, a CA0 record must also be sent. CA1 is only supplemental to indicate that the patient is also a Native American Indian. If the two fields from these records don't match, the claim will be denied.

CA1 field 4, positions 23 - 32, is the purchase order number. This is the number that was assigned to the purchases at the time services were provided.

CA1 field 5, positions 33 - 35, is a three character code for the patient's tribe.

CA1 field 6, positions 36 - 42, is the residence code. This is a code for where the patient is residing, usually on a reservation.

CA1 field 7, positions 43 - 48, is the patients health record number and must be filled in.

CA1 field 8, positions 49 - 57, is the authorizing facility number. This is the facility where the patient was treated.

CA1 field 9, position 58, is the multiple claim indicator. This is filled in if more than one claim for this patient is submitted.

CA1 field 10, positions 59 - 320, is filler national and must be blank.

The CA1 record is one of the shortest records in medical billing of claims electronically but it still needs to be sent if the patient is a Native American Indian.