Medi-Cal Update

Local Educational Agency | August 2018 | Bulletin 527

Print Medi-Cal Update
 

1. Phase 3: RTD Generation is Discontinued

The Department of Health Care Services (DHCS) has eliminated the generation of Resubmission Turnaround Documents (RTDs) (Form 65-1). The discontinuation of RTDs will both increase claims processing efficiency and reduce costs.

RTDs were discontinued in multiple phases. The first phase was implemented in November 2017 and the second phase was implemented in February 2018. The third and final phase was implemented in May 2018. The new process will deny claims submitted with questionable or missing information instead of generating an RTD. The generation of RTDs has been completely discontinued and providers will no longer receive RTDs.

The Resubmission Turnaround Document (RTD) Overview section of the Part 1 manual and the Resubmission Turnaround Document (RTD) Completion section of the Part 2 manual are retired. Additional references to RTDs in the Part 1, Part 2, CHDP and Family PACT manuals are removed as well.

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

Provider Manual(s) Page(s) Updated
Acupuncture
Chiropractic
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); remit adv (2, 3)
Adult Day Health Care Centers appeal form (2); cif sub (3); community ipc (5); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Aids Waiver Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Audiology and Hearing Aids
Durable Medical Equipment
Medical Transportation
Orthotics and Prosthetics
Psychological Services
Therapies
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
CHDP chdp trans (2)
Chronic Dialysis Clinics
Clinics and Hospitals
Rehabilitation Clinics
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Expanded Access to Primary Care Program
Heroin Detoxification
Multipurpose Senior Services Program
appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); remit adv (2, 3); ub comp op (3); ub spec op (5)
Family PACT prov rel (2)
General Medicine
Obstetrics
appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); modif (2, 3); remit adv (2, 3)
Home Health Agencies/Home and Community-Based Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); ped (5); remit adv (2, 3); ub comp op (3); ub spec op (5)
Hospice Care Program appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); hospic ge (3); remit adv (2, 3); ub comp op (3); ub spec op (5)
Inpatient Services appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp ip (3)
Local Educational Agency appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3); ub comp op (3); ub spec op (5)
Long Term Care appeal form (2); cif sub (3); forms leg (1–3); forms reo (1); pay ltc comp (6); remit adv (2, 3)
Part 1 0Cgetstart (3); claim sub (7, 11); cmc (4); elig rec (4); prov rel (2); prov tele (14); remit (2); remit and (1)
Pharmacy appeal form (2); cif sub (3); cms comp (11, 23); cms spec (6); forms leg (1–3); forms reo (1); genetic (17); pcf30-1 comp (14); pcf30-1 spec (1); remit adv (2, 3)
Vision Care appeal form (2); cif sub (3); cms comp vc (13); cms spec vc (3); forms leg (1–3); forms reo (1); genetic (17); remit adv (2, 3)
Print Article | Return to Top
 

2. Drug Products Requiring SAR Added for CCS and GHPP

The following drug products are added to the pharmacy list of drugs and nutritional products that require a separate Service Authorization Request (SAR) for the California Children's Services (CCS) program and the Genetically Handicapped Persons Program (GHPP).

Retroactive
Effective Date
Drug Product
July 1, 2017 Sofosbuvir/Velpatasvir/Voxilaprevir
August 1, 2017 Glecaprevir/Pibrentasvir
January 1, 2018 Voretigene Neparvovec-RZYL
February 1, 2018 Tezacaftor/Ivacaftor and Ivacaftor

These drug products are not included in a physician Service Code Grouping (SCG).

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 Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (8); genetic (11)
Print Article | Return to Top
 

3. 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)
Print Article | Return to Top
 

4. September 2018 Medi-Cal Provider Seminar

The September Medi-Cal provider seminar is scheduled for September 18 – 19, 2018, at the Long Beach Marriott in Long Beach, 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 September 4, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 4, 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.

Print Article | Return to Top
 

5. 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.

Print Article | Return to Top
 

6. 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.

Print Article | Return to Top
 

7. 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.

Print Article | Return to Top
 

8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

Print Article | Return to Top


Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.