Medi-Cal Update

Inpatient Services | July 2019 | Bulletin 538

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1. Update: Fiscal Intermediary Transition Frequently Asked Questions

The Department of Health Care Services (DHCS) California Medicaid Management Information System (MMIS) Division is engaged in a multi-year initiative to transition contracts for the Fiscal Intermediary (FI) responsible for the business operations of fee-for-service Medi-Cal.

The transition from the current vendor to the incoming FI, DXC Technology Services, LLC, shall occur on October 1, 2019, with a primary objective being a successful transition without disruptions to state programs, providers or beneficiaries.

As part of our commitment to keeping the provider community informed throughout this process, DHCS began releasing Frequently Asked Questions on the Medi-Cal website. The first round of FAQs was released in a previously published NewsFlash article titled “Fiscal Intermediary Frequently Asked Questions” The following questions and answers are a continuation of this effort.

FI Transition FAQs:

  1. Is Medi-Cal making any changes to Computer Media Claims (CMC)/electronic claim submissions or electronic attachments with the transition to the new FI on October 1, 2019?

    No. Medi-Cal is not making any changes to electronic claims or attachment submission requirements prior to October 1, 2019. Providers and/or submitters are not expected to reapply or retest as part of the vendor transition.

  2. Is Medi-Cal making any changes to the hours of operation for any of the provider or member support areas?

    All areas, with one exception, are retaining the same hours of operation for provider and member support. Effective October 1, 2019, the hours of operation for the Point of Service (POS) Helpdesk/ Internet Help Desk is 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers and submitters may need to update business or operational practices to align with this change.

  3. Will I need to submit my applications via a different portal from the Provider Application and Validation for Enrollment (PAVE)?

    No. If you currently enroll through PAVE, you will continue to enroll through PAVE. The transition to a new vendor does not impact provider enrollment processes or the PAVE provider enrollment portal PAVE.

  4. Will my current provider ID numbers change once the transition occurs?

    No. The transition will have no impact on provider ID numbers; current provider ID numbers will not change once the transition occurs. Additionally, Provider Identification Numbers (PINs) will not change.

  5. Will my application be fully processed if I am already in the enrollment process during the transition?

    The transition will have no impact on the provider enrollment process, or providers who are in the enrollment process during the transition.

  6. How will I be notified of further changes?

    Updates about the transition will be posted on the Medi-Cal website.

    To receive personalized email notifications with links to the most up-to-date information, providers may subscribe to the Medi-Cal Subscription Service (MCSS) MCSS Subscriber Form on the Medi-Cal website.

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2. Proposed Updates to APR-DRG Reimbursement Method for Fiscal Year 2019 – 2020

For state fiscal year 2019 – 2020, the Department of Health Care Services (DHCS) proposed updates to the all patient refined diagnosis-related group (APR-DRG) reimbursement method for general acute inpatient hospital services provided by the following:

If approved, the following would be effective for dates of service on or after July 1, 2019:

DHCS encourages interested parties to visit the Proposed State Plan Amendments page of the DHCS website, which provides more details regarding the proposed APR-DRG reimbursement method updates for state fiscal year 2019 – 2020. Providers may contact DHCS at

This provider bulletin is published under the authority specified in paragraph (2) of subdivision (f) of Section 14105.28 of the Welfare and Institutions Code (W&I Code), which provides in part:

“Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, or any other provision of law, the department may implement and administer this section by means of provider bulletins, all-county letters, manuals, or other similar instructions, without taking regulatory action.”

This provider bulletin governs should there be a conflict between this provider bulletin and any previous Department published provider bulletins, all-county letters, manuals, or other similar instructions relating to W&I Code Section 14105.28.

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3. Directory Update for Inpatient Mental Health Services Program

The county and state offices information has been updated in the Inpatient Mental Health Services Program: Plan Authorization Directory section of the Part 2 manual.

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

Provider Manual(s) Page(s) Updated
Inpatient Services inp ment pln (1–9)
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4. Counseling to Prevent Perinatal Depression is Now Reimbursable

Effective for dates of service on or after February 12, 2019, and consistent with the U.S. Preventive Services Task Force recommendation, Medi-Cal will now reimburse individual and/or group counseling sessions for pregnant or postpartum women with certain depressive, socioeconomic and mental health related risk factors. These risk factors include perinatal depression, a history of depression, current depressive symptoms (that do not reach a diagnostic threshold), low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety symptoms and a history of significant negative life events.

Up to a combined total of 20 individual counseling (CPT codes 90832 and 90837) and/or group counseling (CPT code 90853) sessions are reimbursable when delivered during the prenatal period and/or during the 12 months following childbirth. Modifier 33 must be submitted on claims for counseling given to prevent perinatal depression.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
preg early (2); preg post (4); prev (8)
Home Health Agencies/Home and Community-Based Services
Inpatient Services
preg post (4)
Obstetrics preg early (2); preg post (4)
Psychological Services psychol (1, 3, 4, 9)
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5. Policy Clarification: Criteria for Cost Avoidance of Prenatal Care Services

A previous Medi-Cal Update article titled “Prenatal Care for Medi-Cal Recipients with OHC is Subject to Cost Avoidance” that published on December 14, 2018, stated that prenatal care services claims for Medi-Cal recipients with Other Health Coverage (OHC) are cost avoided. The following expands on existing criteria for cost avoidance of these claims.

Prior to the Bipartisan Budget Act of 2018, prenatal care services were subject to the optional “pay and chase” method for claim reimbursement. Under the “pay and chase” method, if Medi-Cal reimbursed a service provided to a recipient who also had OHC, Medi-Cal may have attempted to bill the OHC to cover part or all of what Medi-Cal has paid on the claim. This method included claims reimbursed under the global maternity services billing option when prenatal care services could not be differentiated from labor, delivery and postpartum care.

In accordance with the Bipartisan Budget Act of 2018, Section 53102, all prenatal care services are subject to cost avoidance. In addition, any “pay and chase” claim that is bundled with prenatal care services will result in the entire claim being cost avoided.

Standard coordination of benefits will continue to occur for all claims submitted.

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.

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6. Correction: Hospice Eligibility, Billing and Payment Requirements

A previous article that published in the April 2019 Medi-Cal Update titled “Hospice Eligibility Billing and Payment Requirements for Board and Care” incorrectly included the recipient’s physician in the list of those who can sign the hospice election form. The corrected article follows:

Hospice providers are reminded that once a recipient has made the decision to elect, revoke or re-elect participation in the hospice program, the provider is required to complete and submit the hospice notification of election statement to the Hospice Unit of the Medi-Cal Eligibility Division in the Department of Health Care Services (DHCS). The hospice election form cannot be processed by DHCS unless it is signed by the recipient or the recipient’s authorized representative. By choosing hospice election, the recipient will receive certain services as specified in the Hospice Care section in the appropriate Part 2 provider manual. Providers should send all forms to the address below:

Attn: Hospice Clerk
Department of Health Care Services
Medi-Cal Eligibility Division, MS 4607
1501 Capitol Avenue, Room 4063
P.O. Box 997417-7417
Sacramento, CA 95899-7417

Hospice providers are also reminded of the binding federal regulations and the requirement to accept responsibility for the management, billing and payments associated with hospice services in a long term care (LTC) setting (room, board and hospice service). The federal regulations further describe the requirements for a hospice plan of care and criteria for participation in providing hospice services within an LTC setting, and are located in:

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
Hospice Care Program
Inpatient Services
General Medicine
hospic (2)
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7. August 2019 Medi-Cal Provider Seminar

The August Medi-Cal provider seminar is scheduled for August 14 - 15, 2019, at the Long Beach Marriott in Long Beach, California. Providers can access a class schedule for the seminar by visiting the Provider Training 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 (CA-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 July 31, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After July 31, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.


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 regional 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


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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