Medi-Cal Update

Local Educational Agency | March 2020 | Bulletin 546

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1. The Medi-Cal Learning Portal Will Soon Be Upgraded

The Medi-Cal Learning Portal (MLP) will soon be upgraded and users will experience a new look, feel and navigational changes. The MLP is hosted using a commercial off-the-shelf software application that automates the administration, tracking and reporting of training events. The MLP publishes training material and curriculum on the internet and manages the training programs for the provider and billing communities.

The functions of the upgraded MLP are easy to navigate, and users will have logical, straight-forward access to much of what they need. The new MLP enables a blended approach to learning, combining classroom delivery, business and technical workshops, virtual classrooms, e-learning and one-on-one mentoring.

The refreshed Medi-Cal Learning Portal page will continue to be accessible from either its original location or from the Outreach & Education page of the Medi-Cal website. There will be no changes to how users will reach the upgraded MLP.

With some of the new or improved features, users will be able to:

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2. LEA Benefits: Health Behavior Assessments and Interventions

Effective for dates of service on or after January 1, 2020, the following CPT® codes are Local Educational Agency (LEA) Medi-Cal Billing Option Program benefits:

CPT Code Description LEA Program Usage
96156 Health behavior assessment, or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making) Psychosocial status assessment or health/nutrition assessment
96158 Health behavior intervention, individual, face-to-face; initial 30 minutes Psychology/counseling
96159 each additional 15 minutes
96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
96165 each additional 15 minutes

The codes listed above replace previous LEA benefit codes 96150 – 96153. Effective for dates of service on or after December 31, 2019, codes 96150 – 96153 are no longer LEA benefits. An Erroneous Payment Correction will be made for all denied claims.

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

Provider Manual(s) Page(s) Updated
Local Educational Agency loc ed bil cd (8–23); loc ed bil ex (13, 15); loc ed serv nurs (5); loc ed serv physican (5–7); loc ed serv psych (7–9)
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3. Claims with Telehealth Modifier 95 Erroneously Denied

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting Local Educational Agency (LEA) claims. This issue caused claims billed with modifier 95 to erroneously deny. This issue affects claims with dates of service on or after July 1, 2019.

No action is required of providers. DHCS and the California MMIS Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.

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4. Electronic SAR Now Supports Attachments

The California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can now submit Service Authorization Requests (SARs) in an electronic format (eSARs) 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:

  1. Utilize the enhanced online fillable form of the PEDI system to submit eSARs with the attachment

  2. Generate and submit one of the supported file-based transmission formats:
    • Web-based file upload utility in the eSAR system to submit ASC X12 275/278 transactions

    • Simple Object Access Protocol (SOAP)/Hypertext Transfer Protocol Secure (HTTPS) secure web services method to transmit and receive ASC X12 275/278 transactions

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
Hospice Care Program
Inpatient Service
Local Educational Agency
Obstetrics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (12)
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5. New Provider Web Page Coming Soon to the New Medi-Cal Provider Website

The Department of Health Care Services (DHCS) will launch a New Provider web page with the upcoming release of its new Medi-Cal Provider website.

This new web page will offer an organized location for critical information, helpful documents and charts, as well as key links that a “new provider” will need to ensure a successful setup and future as a provider within the Medi-Cal program.

The “New Provider” web page will include information on the following critical Medi-Cal subjects:

DHCS projects a spring 2020 launch. It is recommended that providers continually check the current Medi-Cal website for updates. Providers are also encouraged to subscribe to the convenient and free Medi-Cal Subscription Service (MCSS) to ensure they receive the latest policy news and program updates immediately and regularly.

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6. May 2020 Medi-Cal Provider Seminar

The May Medi-Cal provider seminar is scheduled for May 12, 2020, at the Red Lion Hotel 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 MMIS Fiscal Intermediary 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 24, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 24, 2020, 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. To contact the regional representative for your area, 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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7. Reminder: Screening for Adverse Childhood Experiences Is a Medi-Cal Benefit

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal benefit. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics will also be able to receive these reimbursements, in addition to their Prospective Payment System (PPS) and all-inclusive per-visit reimbursement.

Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be reimbursed more than once per year, per provider. Screenings for individuals 21 years of age or older will not be reimbursed more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age or older. For individuals 18 or 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age or older is used, it must contain questions on the 10 original categories of ACEs to qualify.

ACEs screenings will be reimbursed in both the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with either of the two HCPCS codes below:

These codes may be billed to Medi-Cal directly even if the recipient has Other Health Coverage (OHC).

For fee-for-service Medi-Cal providers, screenings for ACEs are reimbursed at the Medi-Cal rate up to $29. For Medi-Cal MCPs, screenings for ACEs are reimbursed no less than $29 for each qualifying ACEs screening. Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the recipient and/or family and any clinically appropriate actions were documented. This documentation should remain in the recipient’s medical record and be available upon request. The Department of Health Care Services (DHCS) will release additional information in a future announcement about how FQHCs, RHCs and IHS-MOA clinics can bill for trauma screening.

In order to be eligible for the trauma screening reimbursement after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS launched www.ACEsAware.org, which includes information about DHCS’ provider training and other resources.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care Provider Trainings page of the DHCS website.

An Erroneous Payment Correction (EPC) will be implemented to reprocess any claims erroneously denied for dates of service on or after January 1, 2020. Providers should continue to bill their claims timely and check for updates on the Medi-Cal website.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
General Medicine
Medical Transportation
Obstetrics
oth hlth cpt (4)
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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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