Medi-Cal Update

Durable Medical Equipment and Medical Supplies | March 2017 | Bulletin 498

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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 (www.medi-cal.ca.gov)
  • 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 “@conduent.com” address rather than an “@xerox.com” 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 http://www.medi-cal.ca.gov and completing the MCSS Subscriber Form. For more information about Conduent, visit https://www.conduent.com.

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3. Extended Deadline of the Streamlined Procedure for ACA-Related Appeals

The filing period for submission of Patient Protection and Affordable Care Act-related (ACA) appeals is extended from June 30, 2016, to December 31, 2017. The deadline has been extended to assist providers in completing all their ACA-related appeals.

The Streamlined Procedure for ACA-Related Appeals published February 23, 2016, details the submission of appeals regarding ACA payments for Medi-Cal services. Providers should closely follow the article's instructions in all regards except for the filing deadline.

Providers with questions may call the Telephone Service Center at 1-800-541-5555.

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4. Licensed Midwives Can Now Perform Obstetrical Services Independently

Effective retroactively for dates of service on or after July 1, 2015, licensed midwives (LMs) are authorized to enroll independently as Medi-Cal providers and perform obstetrical services without supervision of a licensed physician or surgeon pursuant to California Code of Regulations ( CCR), Title 16, Sections 1379.19, 1379.20, 1379.22 and 1379.30. LMs may submit claims to the Department of Health Care Services (DHCS) for services rendered, excluding Comprehensive Perinatal Services Program services where LMs can only be employed as contract service providers.

In compliance with HIPAA, DHCS has authorized the use of modifier U9 as the exclusive modifier to identify services rendered by an LM. The following CPT-4 and HCPCS codes may be submitted for reimbursement by an LM when billed with modifier U9.

CPT-4 Code Definition
31500 Intubation, endotracheal, emergency procedure
51701 Insertion of non-indwelling bladder catheter (eg, straight catheterization of residual urine)
59300 Episiotomy or vaginal repair, by other than attending
59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
59409 Vaginal delivery only (with or without episiotomy and/or forceps);
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
96361     each additional hour
99070 Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered
99460 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant
99461 Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center
99464 Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn
99465 Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output

HCPCS Code Definition
Z1032 Initial comprehensive pregnancy-related office visit
Z1034 Antepartum visit
Z1038 Postpartum visit

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology
Durable Medical Equipment
Chronic Dialysis Care
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (18)
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
non ph (26, 27); modif app (18)
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5. Updates to the List of Enteral Nutrition Products

The List of Enteral Nutrition Products spreadsheet and the Enteral Nutrition section of the provider manual have been updated to provide policy clarification for the specialty infant extensively hydrolyzed product type and correct the product label name for three Camino Pro products.

The amount reimbursed to providers for contracted enteral nutrition products is the estimated acquisition cost (EAC) listed on the List of Enteral Nutrition Products plus a 23 percent markup.

Listing items is not a guarantee of an item's availability. Product numbers approved on a Treatment Authorization Request (TAR) or Service Authorization Request (SAR) must be the product number dispensed to the beneficiary and the product number claimed for reimbursement by the provider. Billing quantities must be appropriate for the product size (quantity) dispensed and product description on the List of Enteral Nutrition Products spreadsheet. Rounding quantities on claims for enteral nutrition products is not permitted.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
enteral (5, 8, 9, 13, 14, 17)
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6. Medical Supplies Updates: Wound Care Advanced Dressings

The List of Contracted Advanced Wound Care Dressings was updated to correct duplicate Universal Product Numbers (UPNs) and remove the erroneously added Hartmann, USA item number 685763.

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7. April 2017 Medi-Cal Provider Seminar

The next Medi-Cal seminar is scheduled for April 25 – 26, 2017, at the Long Beach Marriott in Long Beach, 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 April 11, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 11, 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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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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