Medi-Cal Update

General Medicine | August 2018 | Bulletin 530

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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. Drug Products Requiring SAR Added for CCS and GHPP

The following drug products are added to the pharmacy list of drugs and nutritional products that require a separate Service Authorization Request (SAR) for the California Children's Services (CCS) program and the Genetically Handicapped Persons Program (GHPP).

Retroactive
Effective Date
Drug Product
July 1, 2017 Sofosbuvir/Velpatasvir/Voxilaprevir
August 1, 2017 Glecaprevir/Pibrentasvir
January 1, 2018 Voretigene Neparvovec-RZYL
February 1, 2018 Tezacaftor/Ivacaftor and Ivacaftor

These drug products are not included in a physician Service Code Grouping (SCG).

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (8); genetic (11)
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3. 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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4. PE4PW Applicants: Manual Enrollment and Paper Claims to be Discontinued

Effective October 31, 2018, the Department of Health Care Services (DHCS) is discontinuing the manual enrollment and paper claim processes for assisting individuals to apply for the Presumptive Eligibility for Pregnant Women (PE4PW) program.

PE4PW qualified providers (QPs) who assist individuals to apply should discontinue use of the paper MC 263, Application for Presumptive Eligibility for Pregnant Women Program, and shred old unused forms. Providers will use, instead, the electronic application through the PE4PW web Portal. A printable version (MC 263-P) to gather information from applicants prior to submission of the electronic application is available in English and Spanish in the Transactions area of the Medi-Cal website.

The transition period for existing providers and their staff to move from the manual (paper) process to the previously announced web Portal electronic enrollment process, expires on October 31, 2018.

Claims submitted with paper MC 263 PE Proof of Eligibility identification cards for dates of service on or after January 1, 2019, are not reimbursable. Claims submitted using the paper PE Proof of Eligibility card will only be valid for dates of service prior to January 1, 2019. For dates of service on or after January 1, 2019, claims with the PE Proof of Eligibility identification card will deny.

Qualified providers who are not using the electronic real-time enrollment process are encouraged to transition and minimize impact to their business operations. Requirements and changes for PE4PW are:

Questions concerning enrollment, computer based training and other Presumptive Eligibility for Pregnant Women issues can be sent to PE@dhcs.ca.gov.

Guidelines and instructions for enrolling applicants are available in the Presumptive Eligibility for Pregnant Women (PE4PW) Application Web Portal User Guide.

Providers are encouraged to watch for PE4PW updates in the NewsFlash area on the Medi-Cal website. Providers should also subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to PE4PW by completing the MCSS Subscriber Form on the Medi-Cal website.

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5. Termination of Psoriasis Day Care Local Code Z0308

Effective for dates of service on or after September 1, 2018, local code Z0308 (psoriasis day care) has been terminated due to low or no utilization.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
medne (9); modif used (11); tar field (3)
Chronic Dialysis Clinics
Obstetrics
Rehabilitation Clinics
modif used (11); tar field (3)
Inpatient Services medne (9); tar field (3)
Adult Day Health Care Centers
Audiology and Hearing Aids
Durable Medical Equipment
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Long Term Care
Medical Transportations
Orthotics and Prosthetics
Pharmacy
Psychological Services
Therapies
tar field (3)
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6. ICD-10-CM Diagnosis Codes Added to Certain Molecular Pathology Codes

Effective for dates of service on or after September 1, 2018, the following ICD-10-CM codes are billable with CPT-4 codes 81243 (FMR1 [fragile X mental retardation 1] gene analysis; evaluation to detect abnormal alleles) and 81244 (... characterization of alleles): R48.2, R62.0, R62.50 – R62.59.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
path molec (11)
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7. 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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8. EWC Covered Procedures Quick Reference Sheets Updated

Previously, CPT-4 code 99212 was erroneously listed as billable for new patients only on the Breast Only Primary Care Provider Covered Procedures and Breast & Cervical Primary Care Provider Covered Procedures quick reference sheets. The quick reference sheets have been updated in the Every Woman Counts section to be billable for established patients only.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
ev woman (36, 37)
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9. 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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10. 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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11. Restriction and Administration Updates for Hydroxyprogesterone Caproate

Effective for dates of service on or after August 1, 2018, NDC labeler code 64011 (AMAG Pharmaceuticals, Inc./Lumara Health) is added as a restriction for physician-administered drug hydroxyprogesterone caproate. A 1.1 mL auto-injector administration of this drug is also added.

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

Provider Manual(s) Page(s) Updated
Pharmacy physician (1)
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12. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Changes, effective February 23, 2018
NDC Labeler Code Contracting Company's Name
64011 LUMARA HEALTH

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 (14)
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13. Medi-Cal List of Contract Drugs

The following provider manual section(s) have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs and Drugs: Contract Drugs List Part 4 – Therapeutic Classifications.

A summary of drugs that have been added or changed is shown below. For additional information, click on the link to the manual section and scroll to the page indicated, or use the find feature to search for the particular drug.

Added Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
February 23, 2018 APALUTAMIDE Drug added, administration added, restriction added drugs cdl p1a (14)
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14. Electronic SAR Now Supports Attachments

California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can now submit Service Authorization Requests (SARs) in an electronic format (eSAR) with attachments. Attachments must be in format of PDF, JPG or TIF. Attachments must be less than 15 megabytes (MB) in size, with the sum of all attachments being less than 150 MB. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit eSARs, providers must:

Then, select one of the available options to submit:

Registered providers and clearinghouses can complete and submit the eSAR requests on behalf of the providers and facilities in their network.

Paper SAR submissions remain an option for low-volume SAR providers or submitters who may have technical limitations or practical reasons to do so.

Providers interested in learning more about eSAR submissions should contact the CMS Net Help Desk at cmshelp@dhcs.ca.gov or 1-866-685-8449 for helpful guidance and additional information.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (12); genetic (4)
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15. Provider Orientation

Family PACT

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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16. 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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17. 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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18. 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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19. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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