Medi-Cal Update

Expanded Access to Primary Care Program | February 2016 | Bulletin 497

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1. Mailing Address Update for Paper TAR Submissions

Effective immediately, unless otherwise directed by Medi-Cal, all paper Treatment Authorization Requests (TARs) should be sent to the following location:

TAR Processing Center
820 Stillwater Road
West Sacramento, CA 95605-1630

If a provider submits a TAR to a field office, the TAR will be returned to the provider with instructions to send the TAR to the TAR Processing Center.

For TAR status or issues, providers may call the Telephone Service Center (TSC) at 1-800-541-5555. Providers outside of California may call (916) 636-1980.

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2. Updated Billing Policy for Antepartum Fetal Testing

Effective for dates of service on or after March 1, 2016, local code Z1030 (non-oxytocin fetal stress test) will be terminated. Code Z1030 will be crosswalked to CPT-4 code 59025 (fetal non-stress test).

When billing CPT-4 code 59025 more than 10 times in nine months, 59025 may now be billed in conjunction with ICD-10-CM diagnosis codes O36.8920 – O36.8999 (maternal care for other specified fetal problems).

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

Provider Manual(s) Page(s) Updated
Acupuncture
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
Medical Transportation
Orthotics and Prosthetics
Psychological Services Therapies
cms spec (7)
Adult Day Health Care Centers
Expanded Access to Primary Care Program
Heroin Detoxification
Home Health Agency/Home and Community-Based Services
Hospice Care Program
Local Education Agency
Multiple Senior Services Program
ub spec op (6)
AIDS Waiver Program
Chronic Dialysis Clinics
Rehabilitation Clincs
modif (3); ub spec op (6)
Clinics and Hospitals altern (3); modif (3); preg early (17, 18); preg ex ub (8); presum (28); rates max (4); ub spec op (6)
General Medicine
Obstetrics
altern (3); cms spec (7); modif (3); preg early (17, 18); presum (28); rates max (4)
Pharmacy cms spec (7); presum (28)
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3. 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 January 1, 2016
NDC Labeler Code Contracting Company's Name
11534 SUNRISE PHARMACEUTICAL, INC.
53436 RELYPSA, INC.
57278 ROCKWELL MEDICAL, INC.
58487 NEW HAVEN PHARMACEUTICALS, INC.
58604 SPROUT PHARMACEUTICALS, INC.
59467 HIKMA AMERICAS
61894 SYMPLMED PHARMACEUTICALS
62332 ALEMBIC PHARMACEUTICALS INC.
64842 TAIHO PHARMACEUTICAL CO. LTD.
67308 DUSA PHARMACEUTICALS, INC.
68992 VELOXIS PHARMACEUTICALS
69171 MERRIMACK PHARMACEUTICALS, INC.
69367 WESTMINSTER PHARMACEUTICALS, LLC
69452 BIONPHARMA, INC.
69656 TESARO INC.
69918 AMRING PHARMACEUTICALS, INC.
70211 TYCHASIS CORPORATION
   
Terminations, effective January 1, 2016
NDC Labeler Code Contracting Company's Name
35501 HUCKABY PHARMACEUTICALS, INC.
68040 PRIMUS PHARMACEUTICALS, INC.
76331 W.H. NUTRITIONALS, 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, 11–18)
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4. March 2016 Medi-Cal Provider Seminar

The next Medi-Cal Provider Seminar is scheduled for March 23, 2016, at the Sacramento Marriott in Rancho Cordova, California. Providers can access a class schedule for the seminar by visiting the Provider Training 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 the Fiscal Intermediary for Medi-Cal, Xerox State Healthcare, LLC (Xerox) conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

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 your Regional Representative, you 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 page and refer to it often for current seminar information.

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5. National Correct Coding Initiative Quarterly Update for January 2016

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 valid for dates of service on or after January 1, 2016.

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

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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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