Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | April 2017 | Bulletin 511

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1. Get the Latest Medi-Cal News: Subscribe to MCSS Today


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2. Update: DHCS Fiscal Intermediary Name Change

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 some items.

Operations and interactions with providers are not impacted by this FI name change.

Providers may see this name change in items such as:

  • NewsFlash articles and Medi-Cal Update bulletins
  • Medi-Cal website (
  • Forms and User Guides
  • Provider Manuals
  • Medi-Cal Learning Portal (MLP)
  • Presentations at Provider Training Seminars
  • Provider Letters, such as Erroneous Payment Corrections (EPCs)
  • Additional hard copy correspondence
  • Emails with an “” address rather than an “” address
  • References to the Conduent name when researching mailing addresses or published telephone numbers
Conduent logo

There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same.

Medi-Cal providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to Medi-Cal Update bulletins, NewsFlash articles, and System Status Alerts. Providers may sign up for MCSS by visiting and completing the MCSS Subscriber Form. For more information about Conduent, visit

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3. SSN Removal Initiative to Replace HIC Number on Medicare Cards

The Medicare Access and CHIP Reauthorization Act of 2015 requires Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim (HIC) number on new Medicare cards and will be used for transactions such as billing, eligibility status and claim status.

A transition period will allow providers to use either the HIC number or the MBI. The transition will begin no earlier than April 1, 2018, and run through December 31, 2019.

CMS currently uses SSN-based HIC numbers to identify Medicare recipients and have used HIC numbers with state Medicaid agencies, health care providers and health plans. Under the new system, CMS will assign a new MBI and send a new Medicare card for each recipient enrolled in Medicare. The MBI should be protected as Personally Identifiable Information (PII).

Additional resources can be found on the Providers and Health & drug plans Web pages of the CMS website.

Additional information regarding this transition will be announced in a future Medi-Cal Update.

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4. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective April 1, 2017
NDC Labeler Code Contracting Company's Name
13517 E5 PHARMA, LLC
63646 TOLMAR, INC.
Terminations, effective April 1, 2017
NDC Labeler Code Contracting Company's Name

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Rehabilitation Clinics
drugs cdl p5 (6, 11, 14, 16, 18, 19)
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5. Resolved: Non-Home Health Claims Erroneously Denied with RAD Code 0076

A claim processing issue that caused non-Home Health claims to be erroneously denied with Remittance Advice Details (RAD) code 0076: The submitted documentation was not adequate has been resolved.

As a reminder, providers who are not required to record a revenue code on their claims should always leave blank the Revenue Code field (Box 42).

Affected claims will be re-processed by an Erroneous Payment Correction (EPC). No action is required of providers. Providers are encouraged to check the Medi-Cal website regularly for updates regarding this issue.

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6. 2017 IHS-MOA Reimbursement Rates Update

Effective for dates of service on or after January 1, 2017, the 2017 reimbursement rates for Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, clinics have been updated. The rates were published in the Federal Register Volume 82, Number 11 on January 18, 2017.

Providers do not need to resubmit claims to adjust their payments. Affected claims for dates of service on or after January 1, 2017, will be reprocessed with an Erroneous Payment Correction (EPC).

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7. FQHC/RHC/IHS-MOA Code Conversion Readiness Checklist

The following checklist has been prepared in anticipation of the Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC) and Indian Health Services/Memorandum of Agreement (IHS-MOA) code conversion to replace two-digit local codes with HIPAA-compliant procedure codes, which is scheduled to implement on October 1, 2017. This is intended to be a general guide, not a comprehensive project plan for providers. Medi-Cal recommends that providers use this checklist as a guideline to prepare themselves for the code conversion implementation.

Getting Ready for the FQHC/RHC/IHS-MOA Code Conversion Implementation:
Plan, Communicate and Review

Requires Immediate Attention

Recommended Start Date: April 2017
  • Review FQHC/RHC/IHS-MOA resources from Medi-Cal, CMS, vendors/billing contractors and other resources.
  • Notify your staff of the future code conversion implementation.
  • Assemble a code conversion project team to handle tasks and oversee the implementation. Be sure to include individuals from different business units affected by the code conversion.
    • Assign individual tasks to different members of the code conversion team such as the completion of system changes and testing, providing of training and education, and modification or development of policies/procedures and reports. At group meetings, assess progress of the implementation.
  • Assess the effects of the code conversion on your organization.
    • Assess the effect on all business units.
    • Identify current learning/skill gaps for coding staff.
  • Create a plan of action to address the code conversion.
    • Identify goals and develop a strategy to undertake the code conversion.
    • Keep concise and consistent messages as part of a communication strategy to educate stakeholders (upper management, IT staff and other transitory staff).
  • Business Partner Preparedness: Assess the timeframe it will take other billing service contractors to get ready for the code conversion. Assess contractor preparedness by using a timeline for upgrading the system. Providers are strongly encouraged to routinely check the monthly Medi-Cal Provider Bulletins as well as the Medi-Cal Learning Portal Training Calendar for announcements of upcoming training and webinars developed for FQHC/RHC/IHS-MOA providers.
  • Review the following code conversion crosswalks for a full description of the new HIPAA-compliant billing code sets:
FQHC/RHC/IHS-MOA Code Conversion Implementation and Testing

Recommended Start Date: May 2017
  • Conduct high-level training with clinicians and coders.
    • Offer designated coders and other personnel comprehensive instruction for training, mapping and auditing.
  • Begin internal testing and validate the system changes.
  • Begin external testing with vendors and other contractors.
  • Start reviewing coder and clinician preparation and start detailed coding.
  • Get vendors to complete implementation to production-ready systems.
  • Develop a back-up plan for continuing operation if a critical system fails or has any problem during code conversion implementation.
  • Create a communication plan for post code conversion implementation.
Preparing for Go-Live

Recommended Start Date: July 2017
  • Confirm with system contractor(s) that upgrades/enhancements in the contractor system have been completed.
  • Finalize all internal system upgrades and testing.
  • Make any adjustments to results of testing responses and do regression testing.
  • Revisit and conduct a test of the back-up plan to remain operational in case the implementation of the FQHC/RHC/IHS-MOA code conversion poses any problems.
  • Finalize external testing with outside contractors.
  • Coding staff should complete their comprehensive code conversion training prior to the go-live date. It is recommended for training to begin three months before implementation.
  • Resolve any problems/issues that may arise during testing that could have been overlooked.
  • Enact the code conversion communication plan.
  • GO-LIVE: Implement the code conversion by October 1, 2017.
Completing the FQHC/RHC/IHS-MOA Code Conversion Implementation and Post-Compliancy

(Must be completed by October 1, 2017)
  • Complete the code conversion implementation full compliance: October 1, 2017. Codes are required for services provided on or after October 1, 2017.
  • Monitor any errors as they occur.
  • Continue any coding staff training if learning gaps still exist.
  • Check the FQHC/RHC/IHS-MOA Code Conversion FAQs for further information.
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8. National Correct Coding Initiative Quarterly Update for April 2017

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are effective for dates of service on or after April 1, 2017.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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9. May 2017 Medi-Cal Provider Seminar

The next Medi-Cal seminar is scheduled for May 23 – 24, 2017, at the Visalia Convention Center in Visalia, California. Providers can access a class schedule for the seminar by visiting the Provider Training Web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and Conduent, the Fiscal Intermediary for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by May 9, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After May 9, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page of the Medi-Cal website.

Note:  Wi-Fi will not be provided at the seminar, please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training Web page and refer to it often for current seminar information.

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