Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | November 2017 | Bulletin 518

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1. FQHC/RHC Annual Rate Adjustment

Effective for dates of service on or after October 1, 2017, Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) received an annual rate adjustment. Under the Prospective Payment System (PPS), reimbursement rates are increased by 1.2 percent to reflect the current Medicare Economic Index (MEI).

An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims. No action is required of providers.

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2. Medical and Ambulatory Visit Policy Correction in Provider Manual

An error was published in the Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics section of the Part 2 provider manual released with the September 2017 Medi-Cal Update. Incorrect policy for medical and ambulatory visits appeared on pages 3 and 4 of this section. The correct, current medical and ambulatory visit policy was restored to the manual. We apologize for any inconvenience this may have caused. Once the system updates take effect, denied claims will be reprocessed.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Clinics and Hospitals
ind health (3, 4)
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3. Coming Soon: Online PDF RAD and Medi-Cal Financial Summary

Providers will soon be able to securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary. The PDF RADs will be available on the Medi-Cal website under the Transactions Services tab.

Note:  To access the transaction, providers must have a signed Medi-Cal Point of Service (POS) Network/Internet Agreement form on file, an NPI and PIN.

Benefits of PDF RAD
There will be many benefits to accessing RAD and Medi-Cal Financial Summary information online:

No provider payments will be made via PDF RADs. They will be informational only.

Providers should refer to future Medi-Cal Update bulletins for additional information.

Providers also are encouraged to sign up for the ASC X12N 835 transaction using the Electronic Health Care Claim Payment/Advice Receiver Agreement form (DHCS 6246 form). The form, which is expected to be modified in December, is located on the Forms page of the Medi-Cal website (www.medi-cal.ca.gov). The Medi-Cal website contains 835 transactions generated for the last six weeks. For information about 835 transactions, providers may refer to “ASC X12N 835 Transaction” in the Part 1 Medi-Cal provider manual section, Remittance Advice Details (RAD): Electronic.

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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 October 1, 2017
NDC Labeler Code Contracting Company's Name
69809 HLS THERAPEUTICS (USA), INC.
69865 DEPO NF SUB, LLC
70437 PUMA BIOTECHNOLOGY, INC.
70510 MITSUBISHI TANABE PHARMA AMERICA, INC.
70655 RENAISSANCE LAKEWOOD, LLC.
71090 STRONGBRIDGE U.S. INC.
   
Terminations, effective October 1, 2017
NDC Labeler Code Contracting Company's Name
11528 CENTRIX PHARMACEUTICAL, INC.
42546 PRUGEN, INC.
69437 CANTON LABORATORIES, LLC.

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
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (6, 8, 18, 19)
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5. RTD Generation to be Discontinued in Multiple Phases

The Department of Health Care Services (DHCS) will be phasing out the generation of Resubmission Turnaround Documents (RTDs) (Form 65-1) over the next 12 months. The discontinuation of RTDs will both increase claims processing efficiency and reduce costs.

RTDs will be discontinued in multiple phases. The new process will deny claims submitted with questionable or missing information instead of generating an RTD. As DHCS transitions from the use of RTDs to claim denials, providers can expect to receive fewer RTDs. When the project is completed, the use of RTDs will be completely discontinued.

The implementation of each RTD phase-out period will be announced in a future monthly bulletin. Providers are encouraged to routinely check the Medi-Cal website for more information.

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

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails for urgent announcements and other updates shortly, after posting on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form
  2. Enter your email address and ZIP code
  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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