Medi-Cal Update

Home Health Agencies/Home and Community-Based Services | December 2018 | Bulletin 531

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1. EPSDT Home Health Services Code Conversion Policy Overview

Effective for dates of service on or after January 1, 2019, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services, which are currently billed using HCPCS Level III local codes will require specified CPT Category I and/or HCPCS Level II national codes.

Providers submitting Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) with dates of service on or after January 1, 2019, must include the appropriate HIPAA-compliant billing codes described in the EPSDT Home Health Code Conversion Crosswalk published September 2018.

Providers should review their inventory for previously approved TARs/eTARs and SARs/eSARs with EPSDT home health services that have dates of services on or after January 1, 2019. Those TARs/eTARs and SARs/eSARs may be submitted with HCPCS Level III local codes until the end-date of that TAR/eTAR or SAR/eSAR.

If a TAR/eTAR or SAR/eSAR is submitted for the purpose of updating codes in the same authorization period, it will not be reviewed for medical necessity.

Provider Resources
Providers should refer to the EPSDT Services: Home Health section of the HIPAA: Code Conversions web page for a complete list of EPSDT home health resources.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
medi non cpt (1); medi non hcp (2); oth hlth cpt (3)
AIDS Waiver Program
Audiology and Hearing Aids
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Rehabilitation Clinics
medi non hcp (2); oth hlth cpt (3)
Durable Medical Equipment
Orthotics and Prosthetics
Pharmacy
Psychological Services
Therapies
medi non hcp (2)
Vision Care medi non cpt (1); medi non hcp (2)
Adult Day Health Care Centers
Expanded Access to Primary Care Program
Local Educational Agency
Multipurpose Senior Services Program
oth hlth cpt (3)
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2. 2019 CPT Annual Update

The 2019 updates to the Current Procedural Terminology (CPT) codes are available in the 2019 CPT Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

For Specialty Programs, current or future benefits for updated CPT codes are reflected in the following PDF documents:

The code additions, changes and deletions are effective for dates of service on or after January 1, 2019. Please refer to the 2019 CPT code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
Long Term Care
Medical Transportation
Therapies
Vision Care
opt ben exc (7)
Chronic Dialysis Clinics inject cd list (9); modif used (4)
Clinics and Hospitals
General Medicine
anest (13); cardio (8–10); eval (16, 22, 28, 29); ev woman (21, 22, 34, 35); inject cd list (9); modif used (4); non ph (9, 10, 23, 24); once (6, 7); opt ben exc (7); path molec (3–15, 19–22, 25–27, 30–36, 39, 40, 46, 60, 61); presum bill (10); radi (3); radi dia (9, 24); radi dia ult (4); rates max (5); spec (2); surg bil mod (7, 8); surg nerv (4, 5); surg urin (3, 6); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Inpatient Services opt ben exc (7); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Local Educational Agency loc ed bil cd (7); loc ed bil ex (12, 14); loc ed serv psych (6)
Obstetrics anest (13); eval (16, 22, 28, 29); ev woman (21, 22, 34, 35); inject cd list (9); modif used (4); non ph (9, 10, 23, 24); once (6, 7); opt ben exc (7); path molec (3–15, 19–22, 25–27, 30–36, 39, 40, 46, 60, 61); presum bill (10); radi (3); radi dia (9, 24); radi dia ult (4); rates max (5); surg bil mod (7, 8); surg urin (3, 6); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Pharmacy inject cd list (9); opt ben exc (7); presum bill (10)
Psychological Services opt ben exc (7); psychol (4–7, 9); psychol cd (2); spec (2)
Rehabilitation Clinics inject cd list (9); modif used (4); non ph (9, 10, 23, 24); opt ben exc (7)
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3. EPSDT Psychology, Mental & Behavioral Health Code Conversion: TAR/SAR Policy

Effective for dates of service on or after April 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services. These codes will be replaced by HIPAA-compliant CPT Category I national codes, used by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

To view the full code conversion, including relevant additional instructions, refer to the crosswalk on the EPSDT Services: Psychology, Mental and Behavioral Health section of the HIPAA: Code Conversions web page.

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the following instructions:

TAR/eTAR Conversion Policy
Effective for dates of service on or after April 1, 2019, new TARs/eTARs for EPSDT psychology, mental and behavioral health services must include CPT Category I national codes. TARs/eTARs using the HCPCS Level III local codes will only be valid for dates of service ending on or before March 31, 2019.

TARs/eTARs Previously Approved, Retroactive and Deferred
Existing TARs/eTARs with HCPCS Level III local codes, regardless of status (approved, retroactive or deferred), will be invalid and providers will need to end-date TARs/eTARs for dates of service beyond March 31, 2019. Providers will need to submit new TARs/eTARs with the appropriate CPT Category I national code(s) for services on or after April 1, 2019.

TARs/eTARs Submitted After April 1, 2019
All TARs/eTARs submitted on or after April 1, 2019, that require authorization beyond this date must include only CPT Category I national codes.

Providers are strongly encouraged to use eTARs. Provider benefits when using eTARs include: no mail delays or postage, money savings and quicker response time. Additionally, eTARs allow providers to check the status of their TAR at any time. For additional information, providers should look for an upcoming eTAR seminar in their area or call the Telephone Service Center (TSC) at 1-800-541-5555.

Guidelines for TAR/eTAR submissions are located in the appropriate Part 1 provider manual.

SAR/eSAR Conversion Policy
Effective for dates of service on or after April 1, 2019, new SARs/eSARs for EPSDT psychology, mental and behavioral health services must include CPT Category I national codes. SARs/eSARs using the HCPCS Level III local codes will only be valid for dates of service ending on or before March 31, 2019.

SARs/eSARs Previously Authorized with Through Dates Beyond March 31, 2019
Existing SARs/eSARs authorized for dates of service beyond March 31, 2019, must be end-dated. Providers should review their existing EPSDT psychology, mental and behavioral health SARs/eSARs that extend beyond March 31, 2019; and submit a new SAR/eSAR with the appropriate CPT Category I national code(s) to cover any remaining service period after March 31, 2019. At the same time, providers should request existing SARs/eSARs with the HCPCS Level III local codes be end-dated effective March 31, 2019.

SARs/eSARs Submitted After April 1, 2019
Effective for dates of service on or after April 1, 2019, providers may begin requesting SARs/eSARs with CPT Category I national codes. SARs/eSARs using the HCPCS Level III local codes may be submitted only for dates of service ending on or before March 31, 2019. SARs/eSARs with HCPCS Level III local codes received after April 1, 2019, may be denied.

Providers may need to resubmit SARs/eSARs with the appropriate CPT Category I national codes.

eSARs now accept attachments. California Children's Services (CCS) and Genetically Handicapped Persons Program (GHPP) 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 guidance and additional information.

Additional information for this code conversion will publish as details are determined.

Providers are encouraged to watch for EPSDT psychology, mental and behavioral health services updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to EPSDT psychology, mental and behavioral health services.

Providers may also request additional onsite or telephone support via the 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 (916) 636-1200.

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4. EPSDT Psychology, Mental and Behavioral Health Services Code Conversion: FAQs

Effective for dates of service on or after April 1, 2019, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services code conversion will replace HCPCS Level III local codes with HIPAA-compliant CPT Category I national billing codes. EPSDT Psychology, Mental and Behavioral Health Services Code Conversion Frequently Asked Questions (FAQs) are available.

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5. EPSDT Psychology, Mental & Behavioral Health Code Conversion: Technical Support

Effective for dates of service on or after April 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services. These codes will be replaced by HIPAA-compliant CPT Category I national codes, used by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

Providers and submitters who bill for EPSDT psychology, mental and behavioral health services using the ANSI 837P and 837I transactions for electronic billing are encouraged to visit the Testing and Activation Procedures section of the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual.

Submitters may test status to ensure accurate file format, completeness and validity for HIPAA-compliant claims transactions by logging into the Medi-Cal test site using their submitter ID and password. Instructions for CMC testing is located in the Testing and Activation Procedures section of the CMC Billing and Technical Manual.

CMC evaluates the test file and determines if the following requirements have been met for all format types:

Note:

A new test must be submitted when software is upgraded or the submission method changes.

For electronic claim submission questions, contact the Telephone Service Center (TSC) at 1 800-541-5555, select option “4” for the Technical Help Desk and option “2” for CMC.

For additional information, providers may:

Providers are encouraged to watch for EPSDT psychology, mental and behavioral health services updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to EPSDT psychology, mental and behavioral health services.

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6. EPSDT Home Health Code Conversion: TAR/eTAR and SAR/eSAR Policy Notice

Effective for dates of service on or after January 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health Services. These codes will be replaced by HIPAA-compliant CPT Category I and HCPCS Level II national codes, utilized by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

To view the full code conversion, including relevant additional instructions, refer to the crosswalk on the HIPAA: Code Conversions webpage under the EPSDT Services: Home Health heading.

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the following instructions:

TAR/eTAR Conversion Policy
HCPCS Level III local codes will only be valid for dates of service on or before December 31, 2018. Effective for dates of service on or after January 1, 2019, new TARs/eTARs for EPSDT Home Health services must include CPT Category I or HCPCS Level II national codes.

Claims for existing TARs/eTARs authorized with through dates beyond January 1, 2019, may be submitted with HCPCS Level III local codes until the end-date of that TAR/eTAR.

Guidelines for TAR/eTAR submissions are located in the Part 1 Medi-Cal provider manual.

Providers are strongly encouraged to use eTARs. Provider benefits when using the eTAR include no mail delays or postage, money savings and quicker response time. Additionally, eTARs allow providers to check the status of their TAR at any time; providers can also check the status of paper TARs using the TAR number.

For additional information, providers should look for an upcoming eTAR seminar in their area or call the Telephone Service Center at 1-800-541-5555.

SAR/eSAR Conversion Policy
HCPCS Level III local codes will only be valid for dates of service on or before December 31, 2018. Effective for dates of service on or after January 1, 2019, new SARs/eSARs for EPSDT Home Health services must include CPT Category I or HCPCS Level II national codes.

Claims for existing SARs/eSARs authorized with through dates beyond January 1, 2019, may be submitted with HCPCS Level III local codes until the end-date of that SAR/eSAR.

Guidelines for SAR/eSAR submissions are located in the appropriate Part 2 provider manual under California Children’s Services (CCS) Program Service Authorization Request (SAR).

Additional information for this code conversion will publish as details are determined. Providers are encouraged to routinely check the Medi-Cal Update provider bulletins and complete the Medi-Cal Subscription Service (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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7. EPSDT Home Health Services Code Conversion Reminder

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services code conversion will replace non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT Category I and HCPCS Level II national codes. HIPAA mandated these changes to billing requirements for EPSDT home health services.

For claims with dates of service on or after January 1, 2019, providers will use a combination of:

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the instructions provided on the HIPAA: Code Conversions page.

Providers are encouraged to watch for EPSDT home health service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to EPSDT home health services.

For additional information, providers may:

All other questions regarding the EPSDT home health services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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8. Sign Language Interpreter Services Code Conversion Policy Overview

Effective for dates of service on or after January 1, 2019, sign language interpreter services currently billed using HCPCS Level III local codes will be converted to a specified HCPCS Level II national code.

Providers submitting claims with dates of service on or after January 1, 2019, must include the appropriate HIPAA-compliant HCPCS Level II national code described in the Sign Language Interpreter Services Crosswalk published October 2018.

For dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324, Z0326, Z0328 and Z0329 will be discontinued, and any claims submitted with these codes will be denied. HCPCS Level III local codes Z0324 and Z0326 will be replaced by HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes) and revenue code 0969 (other professional fees) for UB-04 claim forms or ANSI 837I transactions.

Modifier code HM (less than bachelor degree level) will be applicable when billing for sign language interpreter services for dates of service on or after January 1, 2019. Modifier code HM is used to denote that the rendering provider is a certified sign language interpreter.

Provider Resources
Providers should refer to the Miscellaneous Services section of the HIPAA: Code Conversions web page for a complete list of sign language interpreter services code conversion resources.

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

Provider Manual(s) Page(s) Updated
Acupuncture
Adult Day Health Care Centers
Chiropractic
Heroin Detoxification
Hospice Care Program
Inpatient Services
Long Term Care
Multipurpose Senior Services Program
Pharmacy
Psychological Services
sign (3)
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
modif app (11); modif used (12); non ph (11, 24); sign (3)
Chronic Dialysis Clinics modif app (11); modif used (12); sign (3)
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (11); sign (3)
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9. EPSDT Home Health Services Local Code Conversion Webinars began in November 2018

Medi-Cal providers now have the opportunity to attend free online webinars pertaining to the code conversion and billing services for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services, effective January 1, 2019.

Webinars are presented live with dates as follows:

Webinars are accessible through the Medi-Cal Learning Portal (MLP). First-time webinar attendees must complete the registration prior to attending. Once registered, providers may view the webinar schedule and RSVP for training on the Provider Training Calendar.

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10. Prenatal Care for Medi-Cal Recipients with OHC is Subject to Cost Avoidance

In accordance with the Bipartisan Budget Act of 2018, Section 53102, prenatal care services are subject to cost avoidance. If the cost for prenatal care services cannot be differentiated from labor and delivery, the entire claim will be cost avoided.

A recipient is required to use their OHC prior to their Medi-Cal coverage when the same service is available under the recipient’s OHC. When a service or procedure is not a covered benefit of the recipient’s OHC, a copy of the original denial letter or Explanation of Benefits (EOB) is acceptable for the same recipient and service for a period of one year from the date of the original denial letter or EOB.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Audiology and Hearing Aids
Chronic Dialysis Clinics
Expanded Access to Primary Care Program
Heroin Detoxification
Hospice Care Program
Local Educational Agency
Medical Transportation
Multipurpose Senior Services Program
Rehabilitation Clinics
oth hlth cpt (3)
Clinics and Hospitals
General Medicine
Obstetrics
oth hlth cpt (3); preg glo (4); preg per (2); preg post (1)
Home Health Agencies/Home and Community-Based Services oth hlth cpt (3); preg post (1)
Inpatient Services preg post (1)
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11. Sign Language Interpreter Services Code Conversion Reminder

The sign language interpreter services code conversion will replace HCPCS Level III local codes, commonly referred to as local codes, with HIPAA-compliant HCPCS Level II national codes. This billing requirement for sign language interpreter services is mandated by HIPAA and is effective for claims with dates of service on or after January 1, 2019.

For claims with dates of service on or after January 1, 2019, the sign language interpreter services code conversion will be replacing HCPCS Level III local codes Z0324 and Z0326 with HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes).

As of January 1, 2019, HCPCS Level III local codes Z0328 and Z0329 used to bill for sign language interpreter services will no longer be reimbursable.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Recipients are not eligible to receive sign language interpreter services in a health facility that is required by law to provide sign language interpreter services.

Providers are encouraged to watch for sign language interpreter service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to sign language interpreter services.

For additional information, providers may:

Questions regarding the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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12. EPSDT Psychology, Mental and Behavioral Health Code Conversion Reminder

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Psychology, Mental and Behavioral Health code conversion replaces non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT Category I national codes. HIPAA mandated these changes to billing requirements for EPSDT psychology, mental and behavioral health services.

For claims with dates of service on or after April 1, 2019, providers will use a combination of:

Providers are encouraged to watch for EPSDT psychology, mental and behavioral health service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update.

Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to EPSDT psychology, mental and behavioral health services.

For additional information, providers may:

All other questions for the EPSDT Psychology, Mental and Behavioral Health Code Conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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13. Diabetes Prevention Program: New Medi-Cal Benefit Coming in 2019

Effective for dates of service on or after January 1, 2019, the Diabetes Prevention Program (DPP) will be a Medi-Cal covered benefit.

Medi-Cal’s program will be consistent with the federal Centers for Disease Control and Prevention’s (CDC’s) guidelines and will also incorporate many components of the Centers for Medicare & Medicaid Services’ (CMS’) DPP in Medicare.

Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC recognition in connection with the National Diabetes Prevention Recognition Program. Medi-Cal’s DPP will include a core benefit consisting of at least 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss. In addition, participants who achieve and maintain a required minimum weight loss of 5 percent from the first core session will also be eligible to receive ongoing maintenance sessions, after the 12-month core services period, to help them continue healthy lifestyle behaviors. The DPP curriculum will promote realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.

Additional Information
Detailed coverage and reimbursement policy will be released in a future Medi-Cal Update. For additional important information concerning the DPP, providers are encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the upcoming changes. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Questions and comments may be emailed to DHCSDPP@dhcs.ca.gov.

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14. 2019 Medi-Cal Provider Training Schedule

The 2019 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 2 – 31 Webinar Information posted on the Medi-Cal website
February 13 – 14 Seminar Concord
Crowne Plaza
45 John Glenn Drive
Concord, CA  94520
March 13 – 14 Seminar Ontario
Ontario Airport Hotel & Conference Center
700 North Haven Ave.
Ontario, CA  91764
April 17 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
May 15 – 16 Seminar Escondido
California Center For The Arts
340 N. Escondido Blvd.
Escondido, CA  92025
June 4 – 27 Webinar Information to be posted on the Medi-Cal website
July 17 – 18 Seminar Sacramento
Sheraton Grand Sacramento Hotel
1230 J Street
Sacramento, CA  95814
August 14 – 15 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
September 17 – 18 Seminar Visalia
Visalia Convention Center
303 E. Acequia Ave.
Visalia, CA  93291
October 29 – 30 Seminar Pasadena
Pasadena Convention Center
300 E. Green Street
Pasadena, CA  91101
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15. January 2019 Medi-Cal Provider Training Webinars

Beginning January 2, 2019, and continuing throughout the month of January, Medi-Cal providers may participate in provider training webinars:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have Internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

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16. February 2019 Medi-Cal Provider Seminar

The February Medi-Cal provider seminar is scheduled for February 13 – 14, 2019, 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 January 30, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 30, 2019, 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. 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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18. 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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19. 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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20. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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