Medi-Cal Update

Inpatient Services | March 2019 | Bulletin 534

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1. Medi-Cal Website to Get an Updated Look and Feel

This spring, the Medi-Cal website will have an updated look and feel. All of the current content will be migrated to the new website and will be easier to access.

Benefits:

Access to transactions and the Medi-Cal Learning Portal will remain the same.

As the update of the website progresses, the Department of Health Care Services (DHCS) will provide updates on the Medi-Cal website.

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2. Updated Administrative Day Level 1 Rates: 2018 – 2019

Effective for dates of service on or after August 1, 2018, the administrative day level 1 reimbursement rates statewide, including those for hospitals with a Distinct-Part Nursing Facility Level B (DP/NF-B), are updated.

In accordance with the California Code of Regulations, Title 22, Sections 51542 and 51511, a DP/NF-B of an acute care hospital will receive the lesser of its projected costs or the DP/NF-B median rate as its administrative day rate. Acute care hospitals without a DP/NF-B will receive the DP/NF-B median rate as their administrative day rate. The DP/NF-B median rate is $514.95.

Providers should bill using the new rate immediately for dates of services on or after August 1, 2018. Providers do not need to rebill to adjust their payments. The California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) will process any retroactive rate adjustments for claims paid at the old rate for services provided on or after the above date.

For billing or payment questions, providers should call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, excluding holidays.

The Department of Health Care Services (DHCS) will notify providers of their DP/NF-B facility specific rates in a separate letter. Providers may find their rates on the Long Term Care Reimbursement page of the DHCS website.

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

Provider Manual(s) Page(s) Updated
Inpatient Services admin (4)
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3. Update: HPE Application Portal System Modifications and User Requirements

The effective date has been updated to June 3, 2019, which modifies the Hospital Presumptive Eligibility (HPE) Application Portal system user access.

In the meantime, if HPE provider/employee users have not done so, please confirm and/or update HPE user information, as indicated in the April 2, 2018, HPE NewsFlash Modifications to the HPE Computer Based Training and HPE Application Portal, which provides detailed instructions and contact information.

These modifications will enforce requirements that users are trained and have an appropriate National Provider Identifier (NPI) for authorized access into the HPE Application Portal. Upon implementation, HPE provider/employee users must meet all three user access requirements, outlined below, in order to have authorized access into the HPE Application Portal to make HPE determinations.

If users do not meet each of the three user access requirements, the HPE Application Portal system will deny access.

The following are three new requirements to access the HPE Application Portal:


  1. The HPE provider/employee user must have registered properly on the Medi-Cal Learning Portal (MLP), with either a user type of “Healthcare Provider” or “Provider Staff.” “Healthcare Provider” is defined as a Medi-Cal provider with a valid NPI. “Provider Staff” is defined as anyone working in the provider's office with access to the provider NPI.

  2. The HPE provider/employee user must have successfully completed the HPE Provider/Employee Computer Based Training.

  3. The HPE provider/employee user must have a valid NPI and PIN.
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4. Targeted Genomic Sequence Analysis Panel Added as New Medi-Cal Benefit

Effective for dates of service on or after April 1, 2019, CPT code 81455 (targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes, interrogation for sequence variants and copy number variants or rearrangements, if performed) is a Medi-Cal benefit. An approved Treatment Authorization Request (TAR) is required for reimbursement. A TAR approval requires documentation of the following criteria:

Modifiers 33, 90 and 99 are all allowable. CPT code 81455 is billable once in a lifetime. The frequency limitation may be overridden with a valid TAR.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
once (6); path molec (33); tar and non cd8 (4)
Inpatient Services tar and non cd8 (4)
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5. Updated Guidance for DRG Reimbursed Claims with More Than 22 Line Items

Effective retroactively for dates of service on or after June 6, 2014, diagnosis-related group (DRG) reimbursed claims that contain more than 22 lines should be divided across multiple pages and assigned a unique Claim Control Number (CCN) for each page. A Claims Inquiry Form (CIF) void must be submitted for all CCNs associated with the stay from admit through discharge to recoup any payments prior to the resubmission of a corrected claim. If all reimbursed CCNs are not voided, including CCNs with zero payment, this can cause the resubmitted claim to deny. A reimbursed claim that is not voided causes the new claim to be a duplicate of the previously reimbursed claim (Remittance Advice Details [RAD] code 010).

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

Provider Manual(s) Page(s) Updated
Part 2 cif co (4, 5)
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6. National Correct Coding Initiative Quarterly Update for April 2019

The Centers for Medicare & Medicaid Services (CMS) are scheduled to routinely release the quarterly National Correct Coding Initiative (NCCI) in Medicaid payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and will be effective for dates of service on or after April 1, 2019.

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

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7. April 2019 Medi-Cal Provider Seminar

The April Medi-Cal Provider Seminar is scheduled for April 17, 2019, at the Red Lion Hotel Redding in Redding, 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 California Medicaid Management Information System (MMIS) 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 April 3, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 3, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web 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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8. 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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9. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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