Family PACT Update

April 2018 | Bulletin 127

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1. Family PACT Updates Trichomonas Vaginalis Testing Coverage

Effective for dates of service on or after May 1, 2018, CPT-4 codes 87661 (infectious agent detection by nucleic acid [DNA or RNA]; trichomonas vaginalis, amplified probe technique) and 87808 (infectious agent antigen detection by immunoassay with direct optical observation; trichomonas vaginalis) are benefits for the Family Planning, Access, Care and Treatment (Family PACT) Program.

These codes are for females only and reimbursable when billed with ICD-10-CM codes A59.01, A59.03, N76.0 or Z20.0. Additionally, these codes are reimbursable when billed with the following ICD-10-CM diagnosis codes that identify the contraceptive method for which a client is seen, as listed in the Family PACT Policies, Procedures and Billing Instructions manual: Z30.011, Z30.013, Z30.015, Z30.016, Z30.017, Z30.018, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49 or Z98.51.

CPT-4 code 87808 is a Clinical Laboratory Improvement Amendment (CLIA)-waived test when performed with a CLIA-waived test kit and billed with modifier QW (CLIA-waived test).

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (17, 18); ben grid (15); lab (30)
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2. Family PACT Updates List of Contraceptive Patches

The Family Planning, Access, Care and Treatment (Family PACT) Program adds another strength of the contraceptive patch to the Family PACT manual: norelgestromin and ethinyl estradiol, 4.86 mg/0.53 mg.

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

Provider Manual(s) Page(s) Updated
Family PACT clinic (10); pharmacy (9)
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3. Manual Updates: Online PDF RAD and Medi-Cal Financial Summary

General information about the new PDF RAD has been added to the Medi-Cal provider manual.

Providers can securely view and download a PDF version of their paper Remittance Advice Details (RAD) and Medi-Cal Financial Summary from the Transactions tab of the Medi-Cal website home page.

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.

PDF RAD User Guide Reminder
The PDF RAD Web Portal User Guide is available on the Medi-Cal website. The user guide contains step-by-step instructions to help providers view and download the PDF version of their RAD. Providers may download the guide from the User Guides page of the Medi-Cal website.

 

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

No provider payments are made via PDF RADs. They are informational only.

835 Transactions
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). The form is located on the Forms page of the Medi-Cal website. 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.

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

Provider Manual(s) Page(s) Updated
Part 1 remit (1); remit and (3); remit elect (4)
Acupuncture
Adult Day Health Care Centers
AIDS Waiver Program
Audiology and Hearing Aids
Chiropractic
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Inpatient Services
Local Educational Agency
Long Term Care
Medical Transportation
Multipurpose Senior Services Program
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
remit adv (1)
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4. Phase 2: RTD Generation to Be Discontinued

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

RTDs will be discontinued in multiple phases. The first phase was implemented in November 2017 and the second phase was implemented in February 2018. The third phase is expected to implement in the second quarter of 2018. 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 Medi-Cal Update. Providers are encouraged to routinely check the Medi-Cal website for more information.

In addition, the following Remittance Advice Details (RAD) codes are added to help reconcile provider accounts:

Addition Code Message
9293 Prescription number missing.
9294 Gross amount blank or invalid.
9298 Hospitalization “to” date invalid.

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

Provider Manual(s) Page(s) Updated
Part 1 remit cd 9000 (25); remit elect corr 9200 (14, 15); remit elect corr rarc (1, 4)
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5. Rates Update for Family Planning Drugs

Effective retroactively for dates of service on or after April 1, 2017, the rates for J3490 U5, J3490 U6 and J3490 U8 (unclassified drugs) have been updated as follows:

Code + Modifier Description Effective April 1, 2017 –
June 30, 2017
Effective July 1, 2017 –
September 30, 2017
Effective October 1, 2017
J3490 U5 Ulipristal acetate $35.75 $35.75 $35.75
J3490 U6 Levonorgestrel $24.98 $25.50 $25.01
J3490 U8 Medroxyprogesterone acetate $111.99 $115.53 $113.33

For details on HCPCS code J3490 when billed with modifiers U5, U6 or U8, see the Family Planning section in the appropriate Part 2 manual or the Family PACT Policies, Procedures and Billing Instructions manual.

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) providers.

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6. National Correct Coding Initiative Quarterly Update for April 2018

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 April 1, 2018.

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

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7. Provider Orientation

Medi-Cal providers applying to become a Family Planning, Access, Care and Treatment (Family PACT) provider are required to attend a Provider Orientation per Welfare and Institutions Code (W&I Code), Section (§) 24005(k). The Provider Orientation training is delivered online and in person and includes information on comprehensive family planning, program benefits and services, client eligibility, provider responsibilities and compliance.

Each provider's service location is required to be certified for enrollment in the Family PACT Program. Applicants who are enrolled in Medi-Cal and in good standing or are pending Medi-Cal enrollment and who have submitted a Family PACT application packet may complete the Provider Orientation to certify a site for enrollment.

Each service location must designate one eligible representative to be the site certifier. The site certifier cannot certify multiple sites.

The medical director, physician, nurse practitioner or certified nurse midwife who is responsible for overseeing the family planning services rendered at the location to be enrolled is eligible to certify the site.

Provider Orientation details and registration information is posted on the Family PACT website at www.familypact.org.

Upcoming In-Person Orientation

Los Angeles
June 28, 2018
8:30 a.m. – 12:30 p.m.
California Endowment
1000 North Alameda Street
Los Angeles, CA 90012

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at ProviderServices@dhcs.ca.gov if you have any questions regarding the orientation process.

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8. May 2018 Medi-Cal Provider Seminar

The May Medi-Cal provider seminar is scheduled for May 15 – 16, 2018, at the Double Tree Hilton in Fresno, 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 the DHCS Fiscal Intermediary (FI) 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 1, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After May 1, 2018, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 web 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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9. Reminder: Do Not Staple Paper Claim Forms

Providers are reminded to not staple paper claim forms as staples delay claims processing. For more general reminders about paper claim submission, providers are encouraged to check the Billing Tips: Paper Claims page of the Medi-Cal website.

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11. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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