Files.medi-cal.ca.gov

Medi-Cal: Medi-Cal Update

The 2020 Budget Health Omnibus Trailer Bill – AB 80/SB 102 made that change permanent along with the elimination of the one-dollar pharmacy copay. Therefore, effective January 1, 2021, the monthly 6 Rx per beneficiary limit and the one dollar pharmacy copay will be permanently eliminated.

Actived: 1 days ago

URL: https://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/hom202101.aspx

Medi-Cal: Medi-Cal Update

(1 days ago) The purpose of PERM is to identify erroneous payments made in Medicaid and the Children’s Health Insurance Program (CHIP) in all 50 states and report improper payment estimates to Congress. During RY 2023 PERM, Medicaid and CHIP Medi-Cal claims will be randomly selected for Medical Reviews for the fiscal year beginning July 1, 2021, and

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Medi-Cal: HIPAA: Home Health Code Conversion

(Just Now) HIPAA: Home Health Code Conversion. HIPAA-mandated changes to the billing requirements for the Home Health Agencies (HHA) code conversion are effective for dates of service on or after June 1, 2016. These changes include use of the revenue codes and HCPCS Level II national codes. The following FAQs provide an overview of the conversion to

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Medi-Cal: Medi-Cal Update

(Just Now) Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) 96167: Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes: 96168

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Medi-Cal: Suspended and Ineligible Provider List

(5 days ago) Medi-Cal law, Welfare and Institutions Code (W&I Code), sections 14043.6 and 14123, mandate that the Department of Health Care Services (DHCS) suspend a Medi-Cal provider of health care services (provider) from participation in the Medi-Cal program when the individual or entity has: Been convicted of a felony; Been convicted of a misdemeanor involving fraud, abuse of the Medi-Cal program or

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Medi-Cal: Publications

(1 days ago) Publish Date. 2022 ICD-10-CM/PCS Codes Update. CMS modifications to ICD-10-CM and ICD-10-PCS long and short descriptions for 2022. ICD-10. 09/15/2021. County Medical Services Program Billing Reminder. Reminder that the County Medical Services Program was decommissioned. Providers continuing to submit CMSP claims will be denied.

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Medi-Cal: Login to Medi-Cal

(1 days ago) Login to Medi-Cal. Login Help. WARNING: This computer system is for official use by authorized users and may be monitored and/or restricted at any time. Confidential information may not be accessed or used without authorization. Unauthorized or improper use of this system may result in administrative discipline, civil and/or criminal penalties.

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Medi-Cal: Provider Enrollment

(4 days ago) The Department of Health Care Services (DHCS) Provider Enrollment Division (PED) is responsible for the timely enrollment and re-enrollment of eligible fee-for-service health care providers in the Medi-Cal program. With the implementation of the Provider Application and Validation for …

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Other Health Coverage (OHC) Guidelines for Billing (other

(4 days ago) health care plan. Providers under military benefits health care plans (for example, Tricare) should treat the recipient. For other providers when the benefit is covered under such a plan, that provider should advise the recipient to utilize benefits under the military benefits health care plan.

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Medi-Cal: Provider Home Page

(3 days ago) 7/8/2016. 3/11/2009. 12/26/1990. 7/4/2012. 6/17/2004. 6/10/1987. 85279 1003889502. 672291. 7/27/2010. 8/21/2003. 590342. 10/7/2010. 506530. 28703 2/6/2008. 800512. 8

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Medi-Cal: Medi-Cal Rates

(9 days ago) Medi-Cal Rates as of 08/15/2021. Effective for dates of service on or after March 1, 2009, Medi-Cal payments to providers (unless exempted) will be subject to a 1% or 5% reduction, based on provider type. Welfare and Institutions Code (W&I) Section 14105.191 mandates the application of the 1% and 5% reduction with certain exceptions as noted

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Home Health Agencies (homehealth home-hos)

(4 days ago) Home Health Agencies & Home and Community-Based Services 12 Page updated: September 2020 Home Health Psychiatric Nursing Services HHA services are excluded from coverage by the Mental Health Program (MHP) as set forth in the California Code of Regulations (CCR). However, home health psychiatric nursing is a

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Medi-Cal: Medi-Cal Update

(3 days ago) Effective for dates of service on or after July 1, 2021, the Department of Health Care Services (DHCS) is implementing aid code A1 for the Non-Medi-Cal Hearing Aid Coverage for Children Program. The aid code coverage is limited to specific existing Medi-Cal hearing aid and audiological service policies, providers and billing system to guide the

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Medi-Cal: Medi-Cal Update

(1 days ago) The completed MC 61, signed by the treating health care provider, must be received by the Medi-Cal or MCAP program before the end of the 90-day period following the postpartum period, unless good cause is established. This verification (MC 61) will provide the individual with an additional ten months of coverage, including all mental health

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Medi-Cal: HIPAA: EPSDT Home Health Services

(4 days ago) Health Insurance Portability and Accountability Act (HIPAA) mandated changes to billing requirements for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services will become effective on January 1, 2019. HIPAA was passed by Congress in 1996. In addition to eliminating the use of HCPCS Level III local codes, HIPAA does

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Medi-Cal: Medi-Cal Update

(1 days ago) Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

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Home Health Agencies

(2 days ago) Home Health Agency (HHA) services are excluded from coverage by the Mental Health Program (MHP) as set forth in the California Code of Regulations (CCR), Title 9, Section 1810355(a)(7)(F). However, home health psychiatric nursing is a skilled nursing service that

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Medi-Cal: Hospital Presumptive Eligibility (HPE) Program

(9 days ago) The Patient Protection and Affordable Care Act (ACA) established the Hospital Presumptive Eligibility (HPE) program, which was implemented by the Department of Health Care Services (DHCS) on January 1, 2014. The HPE program provides qualified individuals immediate access to temporary, no-cost Medi-Cal services while individuals apply for

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Medi-Cal: Publications

(5 days ago) DHCS Notice. 07/28/2021. New and Replacement Medication for Beneficiaries Impacted by the State of Emergency. Guidance for dispensing medication and medical supplies for those displaced by the state of emergency caused by the Lava and Beckwourth Complex fires. Pharmacy. 07/23/2021. October 2021 Medi-Cal Provider Training Webinars.

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Medi-Cal: HIPAA: FQHC/RHC/IHS-MOA Code Conversion

(5 days ago) Health Insurance Portability and Accountability Act (HIPAA) mandated changes to billing requirements for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinic providers will become effective on October 1, 2017.

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Medi-Cal: Medi-Cal Coverage of Immunizations

(9 days ago) Health care personnel should administer a dose of Tdap during each pregnancy, irrespective of the recipient's prior history of receiving Tdap.” Department of Health Care Services (DHCS) and California Department of Public Health (CDPH) have defined the components of the Prenatal Tdap Program in the joint letter found here.

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Medi-Cal: EPSDT/CHDP Frequently Asked Questions

(2 days ago) Child Health and Disability Prevention (CHDP) providers billing for services provided to children and youth enrolled in the Medi-Cal fee-for-service health care delivery system must submit claims directly to the California Medicaid Management Information System (MMIS) Fiscal Intermediary in accordance with HIPAA national standards.

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Medi-Cal: Janssen COVID-19 Vaccine

(7 days ago) This guidance is only effective for COVID-19 vaccines purchased by the federal government. At a future date, the Department of Health Care Services (DHCS) will provide an end date to this temporary policy and instruct providers on how they should bill for the reimbursement of provider purchased COVID-19 vaccines.

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Inpatient Mental Health Services Program: Plan

(4 days ago) The Mental Health Plan Point of Authorization Directory lists California county mental health office plan names, addresses and telephone numbers. Please contact the Department of Health Care Services, Mental Health Services Division, County Support Unit if the county contact information needs to be updated.

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Medi-Cal: HIPAA: Code Conversions

(6 days ago) The Health Insurance Portability and Accountability Act (HIPAA) mandates the standardization of internal (administrative) code sets and the use of standard service/procedure code sets for transactions. The Medi-Cal program is using a phased approach to convert its interim (local) codes to national values.

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Medi-Cal: Medi-Cal Update

(3 days ago) As of October 1, 2005, the Department of Health Care Services (DHCS) no longer administers the County Medical Services Program (CMSP). All claims for CMSP services submitted to Medi-Cal after September 30, 2005, are denied. Contact Advanced Medical Management …

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Medi-Cal: Pharmacy FAQs

(2 days ago) A. No. Medi-Cal managed care plans are responsible for drugs to these recipients, except for the carved-out drugs. The carved-out drugs do not need an OHC override to be paid fee-for-service by Medi-Cal. Denial code 0037 "Health Care Plan enrollee, capitated service not billable to Medi-Cal" is your hint that the recipient is Medi-Cal managed care.

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Medi-Cal NewsFlash: Update: DHCS Fiscal Intermediary Name

(7 days ago) January 31, 2017. Effective immediately, providers may notice that the Department of Health Care Services (DHCS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly Xerox State Healthcare, LLC (Xerox), is operating under a new company name, “Conduent.”. Providers may also see the Conduent logo on …

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Medi-Cal: Medi-Cal Update

(1 days ago) Health behavior assessment, or re-assessment (for example, health-focused clinical interview, behavioral observations, clinical decision making) 96158: Health behavior intervention, individual, face-to …

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Medi-Cal: EPSDT/CHDP Frequently Asked Questions: School

(5 days ago) Child Health and Disability Prevention (CHDP) providers billing for services provided to children and youth enrolled in the Medi-Cal fee-for-service health care delivery system must submit claims directly to the California Medicaid Management Information System (MMIS) Fiscal Intermediary in accordance with HIPAA national standards.

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Medi-Cal: Family PACT Update

(3 days ago) The current law, Health and Safety Code Section 120582, allows specified health care providers to prescribe and/or dispense, furnish or otherwise provide antibiotic therapy for sex partners of individuals infected with Chlamydia trachomatis, Neisseria gonorrhoeae, or other STIs as determined by the CDPH, even if the provider has not performed

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Medi-Cal: EPC Letters: 2021

(1 days ago) Health insurance coverage for individuals, families and small businesses. Family PACT. Family Planning, Access, Care and Treatment Program home page. Medi-Cal Dental Program. Medi-Cal Dental home page. California Department of Aging. California Department of Aging home page.

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Batch Eligibility Benefit Inquiry/Response Testing

(9 days ago) The ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response transaction is used to verify patient eligibility information of Medi-Cal recipients. Testing of the 270 transaction is mandatory, whether for the first time or to upgrade to a new format such as 4010A1 to 5010.

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Updated EPSDT Home Health Code Conversion and Billing

(Just Now) Updated EPSDT Home Health Code Conversion and Billing Instructions Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a Medi-Cal benefit for individuals younger than 21 years of age who have full-scope Medi-Cal eligibility. This benefit allows for periodic screenings to determine health care needs.

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Medi-Cal: Financial Cash Control Frequently Asked Questions

(2 days ago) Department of Health Care Services. Financial Audits Branch, Cost Reporting and Tracking Section. MS 2109. P.O. Box 997413. Sacramento, CA 95899-7413. Phone: (916) 650-6696.

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DEPARTMENT OF HEALTH CARE SERVICES

(2 days ago) NCPDP Payer Sheet Department of Health Care Services (DHCS) Version Number: 5.8 September 2021 Materials Reproduced With the Consent of ©National Council for Prescription Drug Programs, Inc.

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Medi-Cal: Medi-Cal Update

(Just Now) Upon expiration of the public health emergency or national emergency, these rates will be amended to amounts that correspond with the clinical laboratory services methodology in Welfare and Institutions Code (W&I Code) Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.

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MCP: An Overview of Managed Care Plans (mcp an over)

(3 days ago) medical professional mental health services. Under the consolidation program, coverage for specialty mental health services is offered through the mental health plans (MHPs) in California’s 58 counties. In most cases, the MHP is the county mental health department. Refer to the Specialty Mental Health Services

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Medi-Cal: Hospital Presumptive Eligibility (HPE) Program

(5 days ago) Notify the Department of Health Care Services (DHCS) of its election to participate in the HPE Program. Agree to the terms and conditions established by DHCS; Ensure hospital staff completes the HPE training program; Instructions will be provided detailing how and when hospitals …

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AEVS: Carrier Codes for Other Health Coverage (aev ohc car)

(9 days ago) A585 First Health A593 Aim Admin A596 Aetna Life/Casualty A604 Premier Access Insurance Co A613 AMD Health Plan A618 First Health A622 ABM Security Services A628 Aramark Service Inc A647 Health Net Dental and Vision A660 Aetna US Healthcare A663 Tister Benefit Administrator A664 First Health

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HIPAA: EPSDT Psychology, Mental and Behavioral Health

(5 days ago) HIPAA-mandated changes to billing requirements for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services are effective August 1, 2019. HIPAA is the acronym for the Health Insurance Portability and Accountability Act which was passed by Congress in 1996.

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Medi-Cal: HIPAA: Crossover Claims

(3 days ago) No. If a provider’s NCPDP claim does not cross over automatically, providers must bill retail pharmacy drug claims with the National Drug Codes (NDC) on the Medi-Cal pharmacy paper claim form 30-1 or 30-4. Can providers submit a crossover claim in the National Council for Prescription Drug Programs (NCPDP) format for a County Organized Health

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Medi-Cal: HIPAA: FAQs

(2 days ago) 270/271 Eligibility Inquiry/Response. 276/277 Claim Status Request/Response. 835 Electronic Remittance Advice. 837 Institutional and Professional. 837 Professional. For more information about HIPAA, call the Telephone Service Center (TSC) at 1-800-541-5555 (out-of …

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Medi-Cal: Provisional Postpartum Care Extension Frequently

(7 days ago) Senate Bill (SB) 104 (Chapter 67, Statutes of 2019). Under SB 104, an individual covered in a pregnancy Medi-Cal aid category may remain eligible under that aid category for up to 12 months after the end of the pregnancy if diagnosed with a maternal mental health condition during their pregnancy, the 60-day postpartum period, or within 90 days from the end of the 60-day postpartum period.

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Medi-Cal: DUR: Board Meetings

(5 days ago) Global Medi-Cal Drug Use Review (DUR) Board meetings are held once per quarter and are open to the public. Most meetings will be held at the Department of Health Care Services, 1700 K Street, 1st Floor Conference Room in Sacramento, California. The 1700 K Street site is a secure building.

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Medi-Cal: Ordering, Referring and Prescribing (ORP

(7 days ago) Additionally, 42 CFR, Section 455.410(c), provides that the State Medicaid agency may rely on the results of the provider screening performed by any of the following: (1) Medicare contractors, (2) Medicaid agencies or (3) Children’s Health Insurance Programs of the States.

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