Medi-Cal Update

Medical Transportation | March 2019 | Bulletin 522

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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. Non-Medical Transportation: Enrollment and Documentation Updates

Changes have been made to the following non-medical transportation (NMT) policy since its first releases in June and November 2018. Updates are shown in bolded type (excluding the subheading).

NMT policy became a covered Medi-Cal benefit effective July 1, 2018.

Pursuant to Welfare and Institutions Code (W&I Code), Section 14132 (ad)(1), NMT is covered, subject to utilization controls and permissible time and distance standards, for eligible full-scope Medi-Cal fee-for-service recipients and pregnant women during pregnancy and for 60 days postpartum, including any remaining days in the month in which the 60th postpartum day falls. NMT includes transporting recipients to and from Medi-Cal covered medical, mental health, substance abuse or dental services.

W&I Code 14132 (ad)(2)(A)(i) defines NMT as including, at minimum, round trip transportation for a recipient to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance.

NMT does not include the transportation of sick, injured, invalid, convalescent, infirm or otherwise incapacitated recipients by ambulances, litter vans or wheelchair vans licensed, operated and equipped in accordance with state and local statutes, ordinances or regulations, as these would be covered as non-emergency medical transportation (NEMT) services.

Registering NMT Vehicles and Enrolling as an NMT Provider
Based upon the authority granted to the director of the Department of Health Care Services (DHCS) in accordance with W&I Code, Section 14132 (ad)(8), the director is establishing Medi-Cal provider enrollment requirements for the provision of NMT services by currently enrolled Medi-Cal NEMT providers that request to provide NMT services by passenger vehicle and for enrolling transportation providers for NMT only. These requirements implement W&I Code, Sections 14043.15 and 14043.26, and as such have the full force and effect of law.

Transportation providers who are currently enrolled in Medi-Cal as NEMT providers and who wish to provide NMT services may request to become NMT providers and provide NMT services, as defined by W&I Code, Sections 14132 (ad)(2)(i) and 14132 (ad)(2)(ii). Current NEMT providers must submit a completed Medi-Cal Supplemental Changes (DHCS 6209) form. NEMT providers requesting to add NMT services should state so in the “Other Information” section of the DHCS 6209 form. NEMT providers wishing to use already reported NEMT vehicles to provide NMT services must also report that to the department in the “Other Information” section of the DHCS 6209 and submit a letter stating they will use existing NEMT vehicles and drivers previously approved by DHCS.

Currently enrolled providers may add new NMT vehicles or NEMT vehicles for NMT on page 13 of the DHCS 6209. Copies of the Department of Motor Vehicles (DMV) vehicle registration and proof of vehicle insurance must be included.

Transportation providers who wish to newly enroll in Medi-Cal to render NMT services will need to submit a completed Medi-Cal Transportation Provider Application package, which includes a Medi-Cal Medical Transportation Provider Application (DHCS 6206) form, a Medi-Cal Provider Agreement (DHCS 6208) form, a Medi-Cal Disclosure Statement (DHCS 6207) form and an application fee.

All applicable information must be completed on the DHCS 6206 or DHCS 6209, which includes:

The NMT organizations/entities shall ensure that all NMT drivers comply with all applicable state and federal licensing and certification requirements and any and all applicable state and federal statutes and/or regulations relating to the operation of a motor vehicle and/or transportation of passengers.

Only enrolled providers who have been approved by DHCS to render NMT services may bill for NMT. The effective date of enrollment for approved NMT services will be retroactive to the date a complete application was submitted.

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

Provider Manual(s) Page(s) Updated
Medical Transportation mc tran gnd (21, 22)
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3. Modifiers Override Medical Justification Requirement

Effective for dates of service on or after March 1, 2019, billing CPT codes 92002 – 92014 (general ophthalmological services) and 99201 – 99499 (Evaluation and Management [E&M] services) with modifier 24, 25 or 57 overrides the requirement of documenting medical justification when billed in conjunction with a surgical procedure as follows:

Modifier Description Application
24 Unrelated E&M service by the same physician or other qualified health care professional during a postoperative period Minor (follow-up days of zero or 10) or major surgical procedures (follow-up days of 90)
25 Significant, separately identifiable E&M service by the same physician or other qualified health care professional on the same day of the procedure or other service Minor (follow-up days of zero or 10) or major surgical procedures (follow-up days of 90)
57 Decision for surgery (major surgery only, day before or day of procedure) Major surgical procedures only (follow-up days of 90)

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (2, 3)
Chronic Dialysis Clinics
Rehabilitation Clinics
modif app (2, 3); modif used (3, 5, 11)
Clinics and Hospitals
General Medicine
Obstetrics
eval (2); modif app (2, 3); modif used (3, 5, 11); surg bil mod (9)
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4. 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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5. 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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6. 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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7. 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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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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