Medi-Cal Update

Home Health Agencies/Home and Community-Based Services | July 2018 | Bulletin 526

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1. EPSDT Program Code Conversion: Policy Overview

Effective for dates of service on or after August 27, 2018, HCPCS Level III local Early and Periodic Screening, Diagnosis and Treatment (EPSDT) service codes Z5830 and Z5868 will be terminated and replaced with HIPAA-compliant national HCPCS Level II codes T1029 and T1026 as shown in the crosswalk below. This conversion will also include the use of the EP modifier to indicate EPSDT services.

Local Code – Description National Revenue Codes – Description National Procedure Codes – Description Modifier – Description
Z5830 – Onsite investigation to detect source of lead contamination rendered by local health department or comprehensive environment agencies. 0969 – Professional fees, other T1029 – Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling EP – Service provided as part of a Medicaid early and periodic screening diagnosis and treatment program (EPSDT).
Z5868 – Pediatric day health care   T1026 – Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour EP – Service provided as part of a Medicaid early and periodic screening diagnosis and treatment program (EPSDT).

Providers should prepare and submit Treatment Authorization Requests (TARs) and Service Authorization Requests (SARs) according to the instructions below.

TAR Conversion Policy for Previously Approved, Retroactive and Deferred TARs
Beginning August 27, 2018, all TARs with HCPCS Level III local code Z5868, regardless of status (approved, retroactive or deferred), will be invalid and providers will need to end-date for dates of service after August 26, 2018. Providers are encouraged to submit new TARs with the appropriate HCPCS Level II national code(s) for services on or after August 27, 2018.

TARs Submitted on or After August 27, 2018
All TARs and eTARs submitted on or after August 27, 2018, which require authorization beyond this date must include only HCPCS Level II national codes.

Providers are strongly encouraged to use eTARs. Provider benefits when using the eTAR include:

Additionally, eTARs allow providers to check the status of their TAR at any time. For additional information, providers are encouraged to look for an upcoming eTAR seminar in their area.

SAR Conversion Policy
Effective for dates of service on or after August 27, 2018, new SARs for EPSDT services must include HCPCS Level II national codes.

SARs Submitted After August 26, 2018
California Children’s Services (CCS)/Genetically Handicapped Persons Program (GHPP) providers should review their EPSDT service SARs that extend beyond August 26, 2018. For those SARs, providers must submit a new SAR with the appropriate HCPCS Level II national code(s) to cover any remaining service period on or after August 27, 2018.

SARs Previously Authorized with Through Dates After August 26, 2018
Effective for dates of service on or after August 27, 2018, SARs authorized with through dates beyond August 26, 2018, must be end-dated. Additionally, providers should request existing SARs with the HCPCS Level III local codes be end-dated August 26, 2018.

SARs Submitted on or After August 27, 2018
Effective for dates of service on or after August 27, 2018, providers may begin requesting SARs with HCPCS Level II national codes. SARs using the HCPCS Level III local codes may be submitted only for dates of service ending before August 27, 2018.

SARs with HCPCS Level III local codes received on or after August 27, 2018 may be denied. Providers may need to resubmit SARs with the appropriate HCPCS Level II national codes.

Additional information for this conversion will publish as details are determined. Providers are encouraged to routinely check the Medi-Cal Update provider bulletins and complete the MCSS Form to receive email notifications for newly published Medi-Cal Update bulletins, Newsflash articles and/or System Status Alerts.

Providers may also request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers calling from outside of California can contact TSC at 1-916-636-1200.

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2. 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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3. Reminder: VeriFone VX 520 POS Device to Decommission in July 2018

In July 2018, the VeriFone VX 520 Point of Service (POS) device will be decommissioned. Providers may contact the POS Help Desk at 1-800-541-5555 (option 5, followed by option 6) for information about the decommission and for options.

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4. Authorized Drug Manufacturer Labeler Codes Update

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

Additions, effective July 1, 2018
NDC Labeler Code Contracting Company's Name
42385 LAURUS LABS LIMITED
59365 COOPERSURGICAL INC.
59917 ADARE PHARMACEUTICALS, INC.
69488 ADVANCED ACCELERATOR APPLICATIONS USA
69584 OXFORD PHARMACEUTICALS, LLC
70727 AERIE PHARMACEUTICALS, INC.
70954 NOVITIUM PHARMA LLC
71274 PHARMING HEALTHCARE INC.
71321 BRANDYWINE PHARMACEUTICALS, LLC
71332 RIGEL PHARMACEUTICALS, INC.
71709 METCURE PHARMACEUTICALS, INC.
71758 AVADEL SPECIALTY PHARMACEUTICALS LLC
71770 MEDUNIK USA

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 (8, 13, 18–20)
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5. National Correct Coding Initiative Quarterly Update for July 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 July 1, 2018.

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

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6. Valid Revenue Codes for Outpatient Services

For dates of service on or after January 1, 2019, a four-digit revenue code must be included on outpatient claims billed on paper UB-04 claim forms (Box 42) or ANSI 837I transactions for electronic billing (FL42; reference ASC X12N 837 v.5010 Loop 2400 Segment SV201).

A revenue code identifies specific accommodations, ancillary services, or unique billing calculations or arrangements. As defined by the National Uniform Billing Committee (NUBC) and required by the HIPAA, services covered in an outpatient setting require a valid four-digit revenue code to accompany the CPT and HCPCS national procedure code(s).

Outpatient claims with dates of service on or after January 1, 2019, that are submitted on paper UB-04 claim forms or ANSI 837I transactions with missing, incomplete, or invalid revenue codes will be denied.

Providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 for claims assistance.

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7. 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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8. August 2018 Medi-Cal Provider Seminar

The August Medi-Cal provider seminar is scheduled for August 14 – 15, 2018, at the Sacramento Marriott in Sacramento, 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 July 31, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After July 31, 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. 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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