Medi-Cal Update

Local Educational Agency | March 2013 | Bulletin 462

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1. Correction to Resumption Date of LEA Withhold for the FY 2012 – 2013

Providers were notified that effective for Local Educational Agency (LEA) claims included on or after the December 17, 2012, checkwrite, the Navigant Consulting, Inc. (NCI) 2.5 percent withhold for fiscal year (FY) 2012 – 2013 would resume. However, this withhold did not resume until the January 22, 2013, checkwrite.

Senate Bill 231, Chapter 655, Statutes of 2001, authorizes this withholding of LEA provider reimbursement. SB 231 requires the annual amount funded not to exceed $1,500,000 per fiscal year.

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2. Update to Litter Van and Wheelchair Transportation Policy

Effective retroactively for dates of service on or after January 1, 2013, the following changes to litter van and wheelchair van transportation apply for Local Educational Agency (LEA) providers.

Litter Van Transportation

Wheelchair Van Transportation

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

Provider Manual(s) Page(s) Updated
Local Educational Agency loc ed serv trans (1)
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3. Subscribe Today to Receive Medi-Cal Notifications via Email

Providers are invited and encouraged to subscribe to the Medi-Cal Subscription Service (MCSS), where subscribers receive email notification of urgent, high-impact announcements and/or monthly Medi-Cal Update bulletins when posted on the Medi-Cal website. Subscribers can choose specific provider communities or subject matters, making it easier to stay up-to-date on the latest Medi-Cal news.

Subscribing to MCSS is easy; go to the MCSS Subscriber Form on the Medi-Cal website and complete the following steps:

  1. Enter an email address and a ZIP code
  2. Select the specific subject matter areas of interest for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts
  3. A confirmation email will be sent to the registered email; click the subscription confirmation link and the registration process is complete

    Note:

    If subscribers are unable to find the subscription confirmation email in their inbox, they should check their junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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4. End Date for ASC X12N 4010A1 and NCPDP 5.1/1.1 Transactions

After March 31, 2013, the Department of Health Care Services (DHCS) will no longer accept claims in the ASC X12N 4010A1 and NCPDP 5.1/1.1 formats.

Due to HIPAA non-compliance, any 4010/4010A1 or NCPDP 5.1/1.1 batch transactions submitted after this date will be rejected and result in non-payment of claims.

Submitters who have not certified or converted to ASC X12N 5010 and NCPDP D.0/1.2 formats can contact the Computer Media Claims (CMC) Help Desk at 1-800-541-5555, option 4 then option 2, to schedule testing.

Additional information can be located on the HIPAA/5010/4010/NCPDP page located under the References tab of the Medi-Cal website.

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5. CMC Error Messages for HIPAA 4010 Transactions

Effective April 1, 2013, Computer Media Claims (CMC) submissions will only be accepted in the HIPAA 5010 format. All ASC X12N 837 v.4010A1 transactions submitted on or after April 1, 2013, will be deleted with CMC error codes 58: Media type/claim type not valid for this submitter and 55: Submitter/claim type not approved for included attachment.

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6. Solutions for Denied MERs from Mandatory Enrollment into a Medi-Cal Managed Care Plan

Recent Medical Exemption Request (MER) processing errors will be addressed through immediate remedies by the Medi-Cal Managed Care program. The All Plan Letter (APL) titled “Processing Errors Related to Denied Medical Exemption Requests Regarding Mandatory Enrollment into a Medi-Cal Managed Care Plan” contains important information for providers who may have submitted a MER on behalf of a beneficiary between March 1, 2011 and October 15, 2012. This letter is posted on the Medi-Cal Managed Care All Plan, Policy, and Duals Plan Letters page of the Department of Health Care Services (DHCS) website.

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7. CCS Service Code Groupings Update

The following codes will be added or end-dated to/from the California Children's Services (CCS) Service Code Groupings (SCGs):

Added Code
Effective Date Code SCGs
October 1, 2012 HCPCS codes A5056, A5057, A9584, A9585, C1830, C9285, C9366, J0131, J0490, J0712, J0840, J1725, J2265, J2507, J7665, Q0162, Q4122–Q4129 and S0119 and CPT-4 codes 49082–49084, 62369, 62370, 74174, 78226, 78227, 78579, 78582, 78597, 78598, 87389, 90869, 92558, 92618, 93998, 95885–95887, 95938 and 95939 01, 02, 03 and 07
October 1, 2012 HCPCS codes C1886, C9287, J0257, J0897, J8561, J9043, J9179, J9228 and S3722 and CPT-4 codes 38232, 81370–81383, 94726–94729, 94780 and 94781 02
October 1, 2012 HCPCS code C9286 03
October 1, 2012 HCPCS code A9272 02 and 07
October 1, 2012 HCPCS code J7326 and CPT-4 codes 20527, 22633, 22634 and 26341 07
October 1, 2012 HCPCS code J7131 03 and 07
October 1, 2012 HCPCS codes C1840 and C9732 and CPT-4 codes 92071 and 92072 10

End-Dated Code
Effective Date Code SCGs
October 1, 2012 HCPCS codes C9272, C9274, C9277, C9280, C9729 and Q2044 and CPT-4 codes 49080, 71090, 73542, 75722, 75724, 78220, 78223, 92070, 92120, 92130, 93875, 94240, 94260, 94350, 94360, 94720 and 94725 01, 02, 03 and 07
October 1, 2012 CPT-4 codes 75940, 78584, 78591, 78593 and 78596 02 and 03
October 1, 2012 CPT-4 code 88318, 01, 02, 03, 07 and 12
October 1, 2012 CPT-4 codes 15175, 15320, 15335, 15340, 15365, 15420 12

Reminder:

SCG 02 includes all the codes in SCG 01, plus additional codes applicable only to SCG 02. SCG 03 includes all the codes in SCG 01 and SCG 02, plus additional codes applicable only to SCG 03. SCG 07 includes all the codes in SCG 01 plus additional codes applicable only to SCG 07.

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 ser (1, 2, 6–19, 21, 23–27)
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