Family PACT Update
January 2012 | Bulletin 52Print Medi-Cal Update
On October 13, 2011, the Department of Health Care Services (DHCS) announced a delay of the HIPAA ASC X12N 5010 and the NCPDP D.0 and 1.2 version implementations for the Medi-Cal fee-for-service (FFS) program. The continued use of the current ASC X12N 4010A1 and NCPDP 5.1 and 1.1 standard transactions is projected for up to one year beyond January 1, 2012.
CMS Compliance Announcement
The compliance date for the implementation of Version 5010 and NCPDP D.0 and 1.2 transactions remains January 1, 2012; however, the Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) announced an Enforcement Discretion period of 90 days. Information on the CMS announcement is available in a November 17, 2011 news article titled Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards on the CMS website.
Providers may visit the Answers page of the U.S. Department of Health and Human Services’ website for additional information and answers to frequently asked questions on the newly mandated transaction standards.
Crossover Claims
Effective January 1, 2012, Medi-Cal will be able to accept and process electronic crossover claims received from the Medicare Coordination of Benefits Contractor (COBC) GHI (Group Health Incorporated). Currently, Medi-Cal receives electronic 837I, 837P and NCPDP crossover claim files from the Medicare COBC GHI. These electronic crossover claims, commonly referred to as “automatic crossover claims,” are transmitted by the COBC to Medi-Cal for processing without provider intervention. Effective January 1, 2012, the returned 835 Remittance Advice will continue to be transmitted in the ASC X12N 4010A1 format.
Crossover claims directly billed to Medi-Cal must continue in the current ASC X12N 4010A1 or NCPDP 5.1 /1.1 formats until further notice.
ASC X12N 5010 Transactions
Medi-Cal’s target implementation date for all other ASC X12N 5010 transactions is July 1, 2012.
The ASC X12N Companion Guide (CG) was released on October 1, 2011. The November 2011 Medi-Cal Update article titled HIPAA 5010 Companion Guides Released, contains links to both the HIPAA 5010 Medi-Cal CG and to a previous article that describes the new CG format.
| Transaction Type | Title | Current Version | New Version |
|---|---|---|---|
| 270/271 | Health Care Eligibility Benefit Inquiry and Information Response | ASC X12N/004010X092 and associated errata A1 | ASC X12N/005010X279 and associated errata A1 * |
| 270/271 | Health Care Eligibility/Spend Down/Spend Down Reversal | ASC X12N/004010X092 and associated errata A1 | ASC X12N/005010X279 and associated errata E1 and A1 * |
| 276/277 | Health Care Claim Status Request and Response | ASC X12N/004010X093 and associated errata A1 | ASC X12N/005010X212 and associated errata E1 and E2 * |
| 835 | Health Care Claim Payment/Advice | ASC X12N/004010X091 and associated errata A1 | ASC X12N/005010X221 and associated errata A1 and E1 * |
| 837I | Health Care Claim: Institutional | ASC X12N/004010X096 and associated errata A1 | ASC X12N/005010X223 and associated errata A1, A2 and E1 * |
| 837P | Health Care Claim: Professional | ASC X12N/004010X098 and associated errata A1 | ASC X12N/005010X222 and associated errata A1 and E1 * |
* X12 errata published July 30, 2010; X12 errata and NCPDP corrections mandated October 13, 2010 via notice in the Federal Register.
NCPDP D.0 and 1.2 Transactions
Medi-Cal’s target implementation date for NCPDP D.0 and 1.2 batch transactions is July 1, 2012. The NCPDP Payer Sheet will be released in December 2011 and will be accessible from the Medi-Cal website.
| Transaction Type | Title | Current Version | New Version |
|---|---|---|---|
| NCPDP D.0 | Retail Pharmacy: Real Time | NCPDP 5.1 | NCPDP D.0, republished August 2010 * |
| NCPDP 1.2 | Retail Pharmacy: Batch | NCPDP 1.1 | NCPDP 1.2 |
* X12 errata published July 30, 2010; X12 errata and NCPDP corrections mandated October 13, 2010 via notice in the Federal Register.
Transaction Testing
The following is the planned schedule for the testing of ASC X12N 5010 and NCPDP D.0 and 1.2 transactions. Beta testing will occur with a group of ASC X12N 5010 and NCPDP D.0 and 1.2 submitters before the mass on-boarding of all submitters begins.
| Task | Target Dates |
|---|---|
| Beta Testing with ASC X12N 5010, and NCPDP D.0 and 1.2 submitters | March – May 2012 |
| Begin Provider/Biller testing for on-boarding of ASC X12N 5010 and NCPDP D.0 transactions | July 1, 2012 |
| Complete on-boarding of submitters for ASC X12N 5010 and NCPDP D.0 Implementation | December 31, 2012 |
Managed Care/Short-Doyle Programs
Separate meetings are in progress to identify and address solutions for Short-Doyle Medi-Cal (SDMC) and Medi-Cal Managed Care Program (MMCP) as they relate to recipient eligibility, spend downs and reversals; carved out FFS claims; files, reports and any other items affected by Medi-Cal’s FFS ASC X12N 5010, and NCPDP D.0 and 1.2 delayed implementation. For SDMC, the current status of 5010 implementation for the Department of Mental Health (DMH) and the Department of Alcohol and Drugs Programs (ADP) SDMC claiming is provided during a weekly scheduled County/trading partner call with listed departments. Please refer to the SDMC – DMH – SD/MC Phase II page of the DMH website for current agenda and issue information.
Resources
Medi-Cal is conducting a survey to gather information on the ability and willingness of providers and claim submitter communities to continue submitting the current ASC X12N 4010A1 and NCPDP 5.1 /1.1 versions beyond January 1, 2012, as well as beyond the 90-day Enforcement Discretion period ending March 31, 2012. Separate surveys are in progress to identify and address solutions for SDMC.
Providers should continue to access the Medi-Cal website and Medi-Cal Updates provider bulletins for updated information on the 5010 and D.0 and 1.2 implementation. In the interim, providers may send suggestions or concerns to their DHCS representative or email the Medi-Cal5010@acs-inc.com mailbox.
The following forms are being added to the Provider Enrollment section of the Family PACT Policies, Procedures and Billing Instructions manual and are also being added to the Forms area of the Medi-Cal website, under the Family PACT heading:
This information is reflected in the following provider manual(s):
| Provider Manual(s) | Page(s) Updated |
| Family PACT | prov enroll (8–38) |
Medi-Cal providers seeking enrollment in the Family PACT (Planning, Access, Care and Treatment) Program are required to attend a Provider Orientation and Update Session. Dates for upcoming sessions are listed below. Registration opens at 8 a.m., with Session I beginning promptly at 8:30 a.m.
Individual and group providers wishing to enroll must send a physician-owner to the session. Non-profit and government clinics seeking to enroll must send their medical director, physician or nurse practitioner who is responsible for oversight of medical services rendered at the service site where the provider wants to enroll.
Office staff members, such as clinic managers, billing supervisors and client eligibility enrollment supervisors, are encouraged to attend. However, these staff members are not eligible to receive a Certificate of Attendance. Enrolled clinicians and staff are encouraged to attend to remain current with program policies and services. Family PACT offers the option for currently enrolled providers and staff to attend only the afternoon session (either the clinical session or the billing and coding session).
Session Format| Start Time | 8:30 a.m. to 2 p.m. |
| Instructions | Attendance at this presentation is mandatory for clinician providers wishing to enroll in Family PACT and is recommended for other staff who are new to the program or need a refresher. |
The afternoon sessions will run concurrently from 2 p.m. to 4 p.m.
Session II – Clinical Practice Alerts:| Start Time | 2 p.m. to 4 p.m. |
| Instructions | Clinicians in attendance who wish to become Family PACT providers must also attend this session. Free continuing education (CE) credit is available for Session II. Providers must bring their medical license number if requesting CE credit; a continuing education request form will be available during onsite registration. Other interested clinical staff are welcome to attend and may request free CE credit for this session. |
| Start Time | 2 p.m. to 4 p.m. |
| Instructions | Administrators and billers interested in Family PACT Program administration and billing information may attend. |
Please note the upcoming Provider Orientation and Update Sessions below.
| San Bernardino March 29, 2012 8:30 a.m. – 4 p.m. Hilton San Bernardino 285 E. Hospitality Lane San Bernardino, CA 92408 (909) 889-0133 |
For a map and directions to these locations, providers can go to the Family PACT website and click “Driving Directions” link for the appropriate session location.
To register for an orientation and update session, providers should:
Registration is submitted in an electronic format only.
Check-In
Check-in begins at 8 a.m. All orientation sessions start promptly at 8:30 a.m. and end by 4 p.m. At the session, providers must present the following:
Individuals representing a clinic or physician group should use the clinic or group NPI, not an individual NPI or license number.
Certificate of Attendance
Upon completion of the orientation session, each prospective new Family PACT medical provider will receive a Certificate of Attendance. Providers should include the original copy of the Certificate of Attendance when submitting the Family PACT application and agreement forms (available at the session) to Family PACT Provider Enrollment. Providers arriving late or leaving early will not receive a Certificate of Attendance. Currently enrolled Family PACT providers do not receive a certificate.
Contact Information
For more information about the Family PACT Program, please call 1-877-FAMPACT (1-877-326-7228) or visit the Family PACT website.
The Family PACT Program was established in January 1997 to expand access to comprehensive family planning services for low-income California residents.
The federal Centers for Medicare & Medicaid Services (CMS) has approved key components of the state’s 2011-2012 budget proposals to reduce Medi-Cal provider payments. Pursuant to Assembly Bill 97 (Committee on Budget, Chapter 3, Statutes of 2011), reductions have been authorized affecting Medi-Cal provider payments for outpatient services. The Department of Health Care Services (DHCS) recognizes that these reductions are difficult for providers.
DHCS has worked diligently on a phased-in implementation approach to reductions and the recoupment of overpayments. The payment reduction will be implemented first, followed by an erroneous payment correction (EPC) at a capped percentage of each checkwrite. It is DHCS’ intent that this approach will mitigate the impact of the reductions to the provider community.
An access analysis has been conducted and a monitoring plan instituted to ensure that adequate access to health care is preserved. DHCS is implementing reductions only where the analysis indicated that access would not be unacceptably impacted. Where the analysis suggested that the impact of reductions would unacceptably compromise access, DHCS reduced or eliminated the proposed reductions.
Reductions will be effective retroactively for dates of service on or after June 1, 2011. DHCS has received federal approval to implement AB 97 payment reductions as follows:
At this time, payment reductions will not be applied to pharmacists or hospital-based skilled nursing facilities.
Payments for services provided under the following programs will be reduced in the same manner as fee-for-service (FFS) Medi-Cal. The percentage reduction will be based upon the provider type billing the service and the age of the patient as noted above.
The rates on file for Los Angeles County Clinics (LACC) reflect the application of the current 1 percent payment reduction to this provider type. Implementation of the 10 percent payment reduction for LACCs will be as follows:
The current statutory exemptions for the 1 percent and 5 percent payment reductions will remain in place. Pursuant to the recent passage of Senate Bills 90 and 335, the payment reductions specified in AB 97 will not be applied to payments for hospital outpatient departments.
EPCs will be issued to reprocess claims and recoup overpayments made to providers during the continued application of the current 1 percent and 5 percent payment reductions for dates of service on or after June 1, 2011. Given the size and complexity of this action, the EPC will be initiated in January 2012 and may continue for several months. DHCS is attempting to mitigate the impact to providers by limiting the amount to 5 percent of the amount to be recouped per checkwrite.
For additional information on the rate reductions, providers may access the DHCS website’s “Frequently Asked Questions” page. Additional questions, including concerns about the EPCs and recoupment of overpayments, may be emailed to rate.reduction@dhcs.ca.gov.
Toll Free Beneficiary Call Line
Additionally, a toll-free Medi-Cal phone number can help answer questions and concerns for Medi-Cal beneficiaries. If a person receives or needs Medi-Cal services, they may call 1-800-541-5555. This number can also be used to help determine a person’s Medi-Cal eligibility and Share of Cost requirements.
Medi-Cal Managed Care (MC) is pleased to announce new enrollment and disenrollment options when calling Health Care Options, the enrollment broker for Medi-Cal MC.
Medi-Cal recipients may call Health Care Options at 800-430-4263 to:
Medi-Cal recipients may contact Health Care Options Monday through Friday from 8:00 a.m. through 5:00 p.m.
Throughout the year, the Department of Health Care Services (DHCS) and the new Fiscal Intermediary for Medi-Cal, Affiliated Computer Services (ACS), will conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, will cover the following topics:
The next seminar is scheduled for January 31, 2012, through February 1, 2012, at the Ontario Convention Center in Ontario, California. Providers can access a class schedule and RSVP for the seminar on the Billing and Claims page of the Medi-Cal Learning Portal (MLP).
Providers are encouraged to bookmark the Provider Seminar Calendar page of the MLP and refer to it often for current seminar information.
Providers may also schedule a custom billing workshop by contacting their Regional Representative in one of the following ways:
Pages updated due to ongoing provider manual revisions:
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