Providers Can Help Patients Keep Their Medi-Cal |
Starting April 1, the Department of Health Care Services (DHCS) is returning to regular Medi-Cal eligibility and enrollment operations. Ahead of this step, the agency has unveiled several resources to help prepare providers and members.
DHCS created a Keep Your Medi-Cal website for members to learn how to update their contact information and sign up for updates, along with a resource toolkit to assist providers and community partners with communicating about the redetermination process. DHCS has also updated its PHE Unwinding Plan, which lays out how the agency will handle Medi-Cal redetermination.
Locally, the County of Orange Social Services Agency (SSA) will lead the redetermination process. SSA will start the 14-month effort by first trying to verify members’ continued eligibility through available data sources. Some members will qualify for automatic renewal through this “ex parte” process. Other members will need to provide information on a renewal form, which will be mailed based on the month they first enrolled in Medi-Cal. SSA advises providers to share the following renewal steps with their patients:
1) Update your contact information with SSA.
2) Create or check your online account at MyBenefitsCalWIN.org.
3) Check your mail for a renewal form in a yellow envelope.
4) Complete your renewal form if you get one.
Help your patients keep their Medi-Cal. Direct them to their online Medi-Cal account at MyBenefitsCalWIN.org or call SSA at 1-800-281-9799.
|
|
|
HEDIS Records Request Coming Soon |
CalOptima Health’s Healthcare Effectiveness Data and Information Set (HEDIS) team is working with J&H Copy Services Inc. to retrieve medical records from contracted providers for annual HEDIS reporting.
Providers will receive a request packet that includes a letter of representation outlining the request, methods to submit medical records, a HEDIS FAQ and a Hybrid Measures Records Needed document. A complete training on the hybrid measure documentation requirements is posted on the CalOptima Health website.
This is a time-sensitive project to retrieve more than 6,000 records in a tight time frame, so please respond promptly to the request for medical records. If you have any questions regarding members on the pull list or measures, please contact Irma Munoz, HEDIS Project Manager, at 714-347-5762 or imunoz@caloptima.org.
|
|
|
March is Colorectal Cancer Awareness Month |
As March is Colorectal Cancer Awareness Month, CalOptima Health is reminding providers of best practices for colorectal cancer screenings.
The U.S. Preventive Services Task Force (USPSTF) has established recommendations for screenings, which are grouped into three tiers based on effectiveness:
- A Recommendation: Screen all adults 50–75 years old
- B Recommendation: Offer screening to adults 45–49 years old
- C Recommendation: Screen adults 75–85 years old based on individual decision, and discontinue screenings after age 85
|
|
|
Virtual Meeting to Cover Important Provider Topics |
CalOptima Health’s Provider Relations department invites contracted providers and their staff to a virtual learn meeting at 1 p.m. on Tuesday, March 14.
The one-hour Zoom meeting will cover:
- CalOptima Health updates
- Grievance and Appeals updates
- Claims updates
- Initial Health Appointment (IHA)/Annual Health Appointment (AHA)
- Annual Wellness Visits (AWVs)
- CalAIM program updates and resources
Contracted providers, office managers, back-office billing staff, authorization staff and any other staff who would benefit from this virtual learn meeting are welcome to attend. Register by clicking on this Zoom link.
|
|
|
Provider and Members Can Receive Annual Wellness Visit (AWV) Incentives |
As part of our commitment to quality care, CalOptima Health is incentivizing providers and members to complete an AWV before the end of the year.
Providers who conduct an AWV with Medi-Cal members over the age of 45 will be reimbursed $125 for each completed AWV per member per calendar year. A $100 supplemental payment will also be available for the submission of each attestation form, supporting medical record and social determinants of health (SDOH) assessments uploaded to the CalOptima Health Provider Portal.
To be eligible, the AWV has to be on a date of service on or after April 1, 2023, for members who are 45 years or older as of December 31, 2022. The supplemental payment is per eligible member per provider group per calendar year.
Claims for completing an AWV should be submitted using the following Current Procedural Terminology (CPT) codes and modifiers:
- For new patients: CPT Code 99205, Modifier 33
- For established patients: CPT Code 99215, Modifier 33
Providers should also remind their Medi-Cal patients over 45 that they are eligible to receive a $50 gift card from CalOptima Health for completing their AWV.
|
|
|
Transportation Authorizations Need Completed Physician Form |
DHCS requires that a Physician Certification Statement (PCS) form be fully completed and signed in order to process requests for and determine appropriate levels of Non-Emergency Medical Transportation (NEMT) services.
This form must be signed by the physician, physician assistant, nurse practitioner, certified nurse-midwife, physical therapist, speech therapist, occupational therapist, dentist, podiatrist, mental health provider or substance use disorder provider giving care to the member and responsible for determining the medical necessity of the transportation.
NEMT services are subject to prior authorization. Incomplete or inaccurate forms, including old request forms and incomplete dates, may cause delays and denials. Once the PCS is submitted, CalOptima Health cannot modify the authorization to a lower level without a new PCS form from the provider. The most current Referral Request for Transportation Services and Physician Certification Statement form can be found on CalOptima Health’s website.
|
|
|
Toolkit Explains Crossover Billing for Dual Eligible Members |
DHCS has shared a toolkit to help providers navigate how to handle crossover billing for Medicare patients who also receive Medi-Cal in 2023.
The new toolkit has information on:
- Transition to Medi-Cal managed care
- Billing processes
- How to submit crossover claims to Medi-Cal plans for Medicare patients
|
|
|
List of Public GEMT Providers Is Now Available |
As a follow-up to interim guidance shared by DHCS on December 30, 2022, the agency has provided a point-in-time list of public ground emergency medical transport (GEMT) providers. The list will assist managed care plans (MCPs) in identifying providers eligible for the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer Program (PP-GEMT).
The PP-GEMT program instituted an add-on increase to the fee-for-service fee schedule for emergency medical transports provided by eligible public GEMT providers. The PP-GEMT add-on is required for all applicable GEMT trips specific to public providers, as defined in Welfare and Institutions Code (WIC) § 14105.945(a)(1).
The list provided by DHCS represents entities that make up the majority of public providers, but it is not all-inclusive and may include some providers who are either not, or are no longer, providing GEMT services. It is intended to be part of the public provider identification process to ensure providers receive timely reimbursement of the PP-GEMT add-on. DHCS has stated that MCPs and health networks have the responsibility of identifying a provider’s public status.
|
|
|
Training Now Available for Annual Cognitive Assessments |
Providers wanting to provide annual cognitive assessments can now access Dementia Care Aware Training.
According to All-Plan Letter (APL) 22-025, managed care plans (MCPs) must cover annual cognitive assessments for their members who are over the age of 65 and not covered by Medicare. Any licensed Medi-Cal provider can conduct and bill for this assessment if it falls within their scope of practice and they are able to bill Evaluation and Management codes. However, they must complete the Dementia Care Aware Training before they can conduct and bill for these assessments. MCPs are not obliged to pay for any cognitive assessments conducted prior to providers completing the training.
|
|
|
Webinars, Phone Line Resources Offered for COVID-19 Therapeutics |
Statewide resources are available for providers with questions about providing COVID-19 therapeutics to their patients.
The University of California, San Francisco National Clinician Consultation Center manages the COVID-19 Therapeutics Warmline, 866-268-4322 (866-COVID-CA), a real-time advice line for free and confidential consultations on COVID-19 testing and treatment. The line is available Monday through Friday, 6 a.m.–5 p.m., with after-hours voicemails returned the next business day.
Through the warmline, California health care providers can speak with an expert clinician or pharmacist about drug-drug interactions or any other clinical challenges. No protected health information is collected during calls.
Providers can also attend the COVID-19 Test to Treat Equity Extension for Community Healthcare Outcomes (ECHO) webinar series. These webinars help clinics and community-based organizations implement their own test and treat programs. The statewide series occurs at noon on the second Wednesday of every month, with the Southern California regional webinar at noon on the third Wednesday of the month.
|
|
|
Please Use Correct Codes for Billing Pregnancy Services |
Primary obstetrician providers billing for pregnancy-related services should ensure they are using the correct codes for these services. These codes are:
- Z1032: Initial antepartum office visit – comprehensive office visit related to pregnancy
- Z1034: Antepartum follow-up office visit
- Z1038: Postpartum follow-up office visit – normally occurs 4–6 weeks after delivery
Only primary obstetrician providers should bill using these codes. All other providers must bill using Evaluation and Maintenance Codes 99242 through 99245.
|
|
|
Policies and Procedures Monthly Update |
Click on the link below to find an outline of changes made to CalOptima Health policies and procedures during February 2023. The full description of the policies below is available on CalOptima Health’s website at:
|
|
|
Health Education: Trainings and Meetings |
Click below for a list of training webinars and links happening in March 2023:
|
|
|
Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- Bebtelovimab No Longer Authorized to Treat COVID-19
- Code Q4158 Added as Medi-Cal Benefit
- Newborn Metabolic Screening Rate Update
- Alpha-Fetoprotein Rate Update
- Clinical Trials Policy
- Policy Updates for CAR-T Cell Therapies
- Policy Updates for Epididymitis under Family PACT and Medi-Cal Programs
- Fluoride Varnish Application Is Not Reimbursable with HCPCS Code D1206
- Correction Made to the List of Contracted Tracheostomy Supplies
- Evusheld No Longer Authorized to Prevent COVID-19
- PP-GEMT IGT Program Reimbursement Rate Add-On
- Special Treatment Programs (STPs)
|
|
|
- CalOptima Health Board of Directors: March 2 at 2 p.m.
- CalOptima Health Joint Provider and Member Advisory committees: April 13 at 8 a.m.
At this time, all meetings have an option for virtual attendance due to COVID-19. Visit the CalOptima Health website for more information.
|
|
|
Follow Us on Social Media |
|
|
CalOptima Health regularly posts on social media to engage members with heath tips, community resources, event dates, program updates and other pertinent information. Follow the agency on Facebook, Instagram, Twitter and LinkedIn.
|
|
|
CalOptima Health, A Public Agency www.caloptima.org
|
|
|
|
|
|
|
|
