Family PACT Update

September 2018 | Bulletin 132

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1. 2019 ICD-10-CM/PCS Diagnosis Code Annual Update

Effective for dates of service on or after October 1, 2018, the Centers for Medicare & Medicaid Services (CMS) has added ICD-10-CM and ICD-10-PCS diagnosis codes for the 2019 ICD-10-CM/PCS annual update.

Information and downloads for these codes can be found at the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update.

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2. Implementation Delay: Automated Hemogram and RSV Laboratory Tests

An article published in the May 2018 Medi-Cal Update, titled Automated Hemogram and RSV Laboratory Tests Added as CLIA-Waived Services, informed providers that certain services are reimbursable as Clinical Laboratory Improvement Amendments (CLIA)-waived tests when performed with a CLIA-waived test kit and billed with modifier QW (CLIA waived test). The article erroneously lists the effective date as June 1, 2018. Due to a delay in implementation, this policy is effective for dates of service on or after October 1, 2018.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

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3. Frequency Limit Update for Laboratory Codes

Effective for dates of service on or after September 1, 2018, the Family Planning, Access, Care and Treatment (Family PACT) Program updated the frequency limits for CPT-4 codes 87491 (infectious agent detection by nucleic acid [DNA or RNA]; Chlamydia trachomatis, amplified probe technique) and 87591 (…Neisseria gonorrhoeae, amplified probe technique) to three tests per recipient, per day.

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam (56, 58); ben grid (11); lab (26, 28)
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4. 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

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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5. October 2018 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 16 – 17, 2018, at the Crown Plaza in Concord, 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 October 2, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 2, 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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6. 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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7. 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 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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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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