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Demand Letters From LA Care
CAMPS has heard from multiple members about recent Notice of Demand Letters being sent to DME and medical supply providers by LA Care. The volume of letters can be substantial with a mail date and time to respond which is less than three weeks. We believe that the claim references are ties to Coordination of Benefit issues that are erroneous as well as denials based on based upon financial liability for a physician group rather than LA Care.
CAMPS has been in contact with LA Care and they have begun outreach to individual CAMPS members who have received hundreds of these Demand Letters in recent weeks. If you are having issues please contact CAMPS.
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Changes to Pharmacy and Compound Drug Pharmacy Claim Forms
Pharmacy Claim Forms 30-1 and 30-1C, as well as Compound Drug Pharmacy Claim Forms 30-4 and 30-4C, are being updated. Below are the relevant dates pertaining to these updates:
- Medi-Cal begins accepting the new forms August 27, 2018
- For original claims, both the new and old claim forms will be accepted through February 28, 2019
- For original claims, providers are required to submit the new forms beginning March 1, 2019
- For appeal claims, providers may submit using the old forms through August 31, 2019
- The old forms will officially no longer be accepted for both original and appeal claims as of September 1, 2019
Providers can order the new forms starting August 24, 2018, by using the Provider Forms Reorder Request and notating "New" next to the quantity. During the transition period, providers can still order the old version of the forms by notating "Old" next to the quantity. Forms can also be ordered by calling the Telephone Service Center at 1-800-541-5555. For instructions on how to complete the Reorder Request, providers may refer to the Forms Reorder Request: Pharmacy section of the Pharmacy provider manual.
Changes to the forms are as follows:
New 30-1 and 30-1C Pharmacy Claim Forms:
- Prescription Number fields (Boxes 11, 32 and 53) have been expanded to accommodate up to 12 digits
- A refill number must be entered into the Fill Number field (Boxes 12, 33 and 54)
- "0" or "00" for original dispensing
- "1" or "01" to "99" for refill
- An Emergency Fill (Boxes 16, 37 and 58) indicator can be entered if applicable. If the drug was dispensed in an emergency, use indicator "Y" for "yes" or "N" for "no."
New 30-4 and 30-4C Compound Drug Pharmacy Claim Forms:
- Prescription Number field (Box 10) has been expanded to accommodate up to 12 digits
- A refill number must be entered into the Fill Number field (Box 11)
- "0" or "00" for original dispensing
- "1" or "01" to "99" for refill
- An Emergency Fill (Box 15) indicator can be entered if applicable. If the drug was dispensed in an emergency, use indicator "Y" for "yes" or "N" for "no."
Note that, due to the addition of two new fields to the forms, claim line 4 has been removed from forms 30-1 and 30-1C. Additionally, ingredient line numbers 24 and 25 were removed from forms 30-4 and 30-4C.
For instructions on how to properly bill using pharmacy claims, refer to the completion and examples sections in the appropriate Part 2 manual. Provider manual updates reflecting these changes will be released in a future Medi-Cal Update.
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Congressional Recess Provides Opportunity to Advocate for Additional Relief for HME
With the House currently on recess until after Labor Day (and the Senate set to join them later next week), the HME community can make a strong impression on their legislators via district-office meetings and at public events. Our industry secured some important gains in the recently-released ESRD/DMEPOS proposed rule, and we have an opportunity to thank legislators who have been supportive on our issues for their efforts so far while also reinforcing that additional relief is needed.
Here are some key points you can make with your legislators in your recess-period contacts:
- Starting in January, all suppliers in competitive bid areas will be able to provide HME until CMS determines when the next bidding round takes place. The current rates used in those bidding areas are unsustainable and need to be adjusted upwards in the interim period before the next bidding round in the Final Rule.
- The proposed ESRD/DMEPOS Rule provides a welcome measure of relief for rural suppliers, but does not address drastic reimbursement cuts for other suppliers in non-bid areas. Maps are available showing the extensive non-bid areas not getting rural relief in many states (these are the green areas called "non-rural" in these maps). Congress has repeatedly expressed their view that these non-bid areas also need the kind of relief afforded to rural areas; CMS needs to extend relief to all non-bid areas in the Final Rule.
- CMS has made it clear that they believe they do not have the authority to address the application of an outdated 2006 budget neutrality offset on oxygen equipment that is resulting in unsustainable rates for some oxygen products. Congress needs to address oxygen reimbursement policy in the next healthcare related legislative vehicle.
This scorecard shows how your legislators have supported industry-backed initiatives such as the Congressional sign-on letter to OMB last September, the sign-on letter to Appropriations leaders this March, and co-sponsorship of HR 4229 and HR 3730. Please don't forget to note these actions of support in your meetings/contacts with your legislators.
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CAMPS Fifth Annual Fall Conference
 Thursday, September 13, 2018
9:00 AM - 4:45 PM
Hosted Cocktail Mixer 4:45- 5:45
Long Beach Yacht Club
6201 E. Appian Way
Long Beach, CA
Topics include:
- Reimbursement/billing
- Medicare audits
- Update on Competitive Bidding
- Managed Care Strategies
- Medi-Cal Managed Care and CCS Whole Child Pilot
- And more.
For more information visit our conference page.
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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