Family PACT Update

August 2018 | Bulletin 131

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1. Phase 3: RTD Generation is Discontinued

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

RTDs were discontinued in multiple phases. The first phase was implemented in November 2017 and the second phase was implemented in February 2018. The third and final phase was implemented in May 2018. The new process will deny claims submitted with questionable or missing information instead of generating an RTD. The generation of RTDs has been completely discontinued and providers will no longer receive RTDs.

The Resubmission Turnaround Document (RTD) Overview section of the Part 1 manual and the Resubmission Turnaround Document (RTD) Completion section of the Part 2 manual are retired. Additional references to RTDs in the Part 1, Part 2, CHDP and Family PACT manuals are removed as well.

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

Provider Manual(s) Page(s) Updated
Acupuncture
Chiropractic
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); remit adv (2, 3)
Adult Day Health Care Centers appeal form (2); cif sub (3); community ipc (5); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Aids Waiver Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Audiology and Hearing Aids
Durable Medical Equipment
Medical Transportation
Orthotics and Prosthetics
Psychological Services
Therapies
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
CHDP chdp trans (2)
Chronic Dialysis Clinics
Clinics and Hospitals
Rehabilitation Clinics
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Expanded Access to Primary Care Program
Heroin Detoxification
Multipurpose Senior Services Program
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Family PACT prov rel (2)
General Medicine
Obstetrics
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3)
Home Health Agencies/Home and Community-Based Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); ped (5); remit adv (2, 3); ub comp op (3); ub spec op (5)
Hospice Care Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); hospic ge (3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Inpatient Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp ip (3)
Local Educational Agency appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp op (3); ub spec op (5)
Long Term Care appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); pay ltc comp (6); remit adv (2, 3)
Part 1 0Cgetstart (3); claim sub (7, 11); cmc (4); elig rec (4); prov rel (2); prov tele (14); remit (2); remit and (1)
Pharmacy appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); pcf30-1 comp (14); pcf30-1 spec (1); remit adv (2, 3)
Vision Care appeal form (2); cif sub (3); cms comp vc (13); cms spec vc (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
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2. Family PACT Claims for CPT-4 Code 87624 Erroneously Denied

The Department of Health Care Services identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program claims for CPT-4 code 87624 (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], high-risk types [eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68]) billed with ICD-10-CM diagnosis codes Z01.42 (encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear) or Z87.410 (personal history of cervical dysplasia) to erroneously deny with Remittance Advice Detail code 9516: The secondary diagnosis code is missing or invalid for the procedure code.

An Erroneous Payment Correction will be issued to reprocess affected claims retroactive to August 1, 2016. No action is required of providers. Providers should continue to submit claims in a timely manner.

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3. CPT-4 Code 87255 Erroneously Denied for Family PACT Program

The Department of Health Care Services (DHCS) identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program claims for CPT-4 code 87255 (virus isolation; including identification by non-immunologic method, other than by cyoptathic effect [eg, virus specific enzymatic activity]) billed with ICD-10-CM diagnosis codes Z30.46 (encounter for surveillance of implantable subdermal contraceptive) and N76.6 (ulceration of vulva) to erroneously deny with Remittance Advice Details (RAD) code 0169: This service is not payable when billed with this diagnosis.

An Erroneous Payment Correction (EPC) will be issued to reprocess affected claims retroactive to August 1, 2016. No action is required of providers. Providers should continue to submit claims in a timely manner.

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4. Update to Clinic Dispensing Limits for Self-Administered Hormonal Contraceptives

Effective for dates of service on or after August 1, 2018, in accordance with Senate Bill 999, the clinic dispensing limits for self-administered hormonal contraceptives is updated for the Medi-Cal and Family Planning Access, Care and Treatment (Family PACT) programs as follows:

The dispensing of up to the maximum quantity is intended for clients on continuous cycle. A 12-month supply of the same product of contraceptive vaginal rings, contraceptive patches or oral contraceptives may be dispensed twice in one year. A Treatment Authorization Request (TAR) is required for the third supply of up to 12 months of the same product requested within a year.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (9)
Family PACT ben grid (24); clinic (5, 6, 8, 10–12); drug (3); pharmacy (6, 9)
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5. Frequency Limit Update for Laboratory Codes

Effective for dates of service on or after September 1, 2018, the following CPT-4 laboratory codes have updated frequency limits:

CPT-4 Code Description Frequency Limit
87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique 3 units/day
87591 Neisseria gonorrhoeae, amplified probe technique 3 units/day
87798 not otherwise specified; amplified probe technique, each organism 13 units/day
87801 multiple organisms; amplified probe(s) technique 3 units/day
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6. Drug Safety Communication: Adverse Effects from Fluoroquinolone Antibiotics

A new DUR Educational Article titled “Drug Safety Communication: Adverse Effects from Fluoroquinolone Antibiotics” (PDF format) is available on the DUR: Educational Articles┬ápage of the Medi-Cal website.

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7. ProDUR Update: Additive Toxicity Alert Now Focused Only On CNS Depressants

A new DUR Educational Article titled “ProDUR Update: Additive Toxicity Alert Now Focused Only On CNS Depressants” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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8. 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

Sacramento
August 22, 2018
10:00 a.m. – 2:00 p.m.
Sierra Health Foundation
1321 Garden Highway
Sacramento, CA 95833
Oakland
September 21, 2018
10:00 a.m. – 2:00 p.m.
California Endowment
2000 Franklin Street
Oakland, CA 94612

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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9. September 2018 Medi-Cal Provider Seminar

The September Medi-Cal provider seminar is scheduled for September 18 – 19, 2018, 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 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 September 4, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 4, 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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10. 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. A New Way to Subscribe – Contact Medi-Cal Subscription Service Representatives

Medi-Cal is committed to keeping you up-to-date on the latest Medi-Cal news and policy updates.

The Medi-Cal Subscription Service (MCSS) is a free service that provides subscribers with personalized email notifications for urgent, high-impact announcements and monthly news/policy updates as they post to the Medi-Cal website.

Providers can now contact MCSS representatives directly at MCSSCalifornia@conduent.com to subscribe and for assistance with managing subscriptions. Subscribing is simple and free!

If you have not yet subscribed to MCSS, Medi-Cal encourages you to utilize one of the following two methods to subscribe.

To subscribe by email:
  1. Download the linked MCSS Subscriber Form

  2. Enter your name, email address, ZIP code and subscriber type in the appropriate fields

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Attach your completed form to an email and send to MCSSCalifornia@conduent.com
To subscribe online:
  1. Go to the MCSS Subscriber Form page on the Medi-Cal website

  2. Enter your email address and ZIP code, and select a subscriber type from the drop-down menu

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Click “Subscribe Now” at the bottom of the page

After the form has been received, 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, visit the MCSS Help page.

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

MCSS Logo

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 shortly after urgent announcements and other updates post 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 and select a subscriber type

  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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13. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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