Medi-Cal Update

Pharmacy | March 2017 | Bulletin 891

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1. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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2. Update: DHCS Fiscal Intermediary Name Change

Effective immediately, providers may notice that the Department of Health Care Services (DHCS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly Xerox State Healthcare, LLC (Xerox), is operating under a new company name, “Conduent.” Providers may also see the Conduent logo on some items.

Operations and interactions with providers are not impacted by this FI name change.

Providers may see this name change in items such as:

  • NewsFlash articles and Medi-Cal Update bulletins
  • Medi-Cal website (www.medi-cal.ca.gov)
  • Forms and User Guides
  • Provider Manuals
  • Medi-Cal Learning Portal (MLP)
  • Presentations at Provider Training Seminars
  • Provider Letters, such as Erroneous Payment Corrections (EPCs)
  • Additional hard copy correspondence
  • Emails with an “@conduent.com” address rather than an “@xerox.com” address
  • References to the Conduent name when researching mailing addresses or published telephone numbers
Conduent logo

There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same.

Medi-Cal providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to Medi-Cal Update bulletins, NewsFlash articles, and System Status Alerts. Providers may sign up for MCSS by visiting http://www.medi-cal.ca.gov and completing the MCSS Subscriber Form. For more information about Conduent, visit https://www.conduent.com.

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3. Extended Deadline of the Streamlined Procedure for ACA-Related Appeals

The filing period for submission of Patient Protection and Affordable Care Act-related (ACA) appeals is extended from June 30, 2016, to December 31, 2017. The deadline has been extended to assist providers in completing all their ACA-related appeals.

The Streamlined Procedure for ACA-Related Appeals published February 23, 2016, details the submission of appeals regarding ACA payments for Medi-Cal services. Providers should closely follow the article's instructions in all regards except for the filing deadline.

Providers with questions may call the Telephone Service Center at 1-800-541-5555.

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4. PE for Pregnant Women Automation Effective April 1, 2017

Effective April 1, 2017, the application process for Qualified Providers (QPs) in the Presumptive Eligibility for Pregnant Women (PE4PW) program, which is used to help applicants apply for interim Medi-Cal services, is automated. QPs are encouraged to begin using the automated Presumptive Eligibility for Pregnant Women Program Application (MC 263), which will be available in the Transactions area of the Medi-Cal website. QPs will be able to use the MC 263-P (paper) form to gather the applicant's information prior to inputting it in the automated system. The MC 263-P is available in both English and Spanish.

Note:

The current paper application process using form MC 263 version 06/2016 will remain available for six months (through September 29, 2017) to ensure all providers have time to transition to the new process. After that date, paper MC 263 forms will not be used/available.

Provider Manual Update: Helping Patients Qualify for Temporary Medi-Cal
The new Presumptive Eligibility for Pregnant Women Program Process manual section contains the automated process instructions providers follow to help patients apply for temporary Medi-Cal (and all other health insurance affordability programs), pending a final eligibility determination.

Provider Manual Update: Provider Enrollment
Additionally, the new Presumptive Eligibility for Pregnant Women Provider Enrollment Instructions section and associated form, Presumptive Eligibility for Pregnant Women Provider Enrollment Checklist, contain instructions to help providers enroll as PE4PW providers.

PE for Pregnant Women Forms
Many of the forms listed on the Presumptive Eligibility for Pregnant Women Web page of the Medi-Cal website will remain in use for dates April 1, 2017 through September 29, 2017. Due to automation, after that date the following forms will no longer be used/available:

The older version of the provider enrollment form MC 311 (version 10/07) will be removed from the website and substituted with a newer version (Qualified Provider Application and Agreement for Participation in the Presumptive Eligibility for Pregnant Women (PE4PW) Program [version 12/16]) on both the Presumptive Eligibility for Pregnant Women Web page and the Forms Web page.

References
For more details about form MC 263 automation and MC 311 changes, providers may refer to the Presumptive Eligibility for Pregnant Women Frequently Asked Questions and the February 2017 bulletin article Automation of PE for Pregnant Women Program. For questions about the PE4PW program, providers may contact the Medi-Cal Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays, as follows:

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
gene coun (2); preg determ (1); preg early (1); presum (1); presum proc (1–7); presum prov (1–5); presum prov enroll frm (1)
Pharmacy pcf30-1 spec (6); presum (1); presum proc (1–7); presum prov (1–5); presum prov enroll frm (1)
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5. HCPCS Codes Added and Terminated for Blood Factors

Effective for dates of service on or after January 1, 2017, the following blood factors are billable with their corresponding HCPCS code:

HCPCS code Description
C9140 Injection, factor VIII (antihemophilic factor, recombinant), (Afstyla), 1 IU
J7175 Injection, factor X, (human), 1 IU *
J7179 Injection, von Willebrand factor (recombinant), (Vonvendi), 1 IU *
J7202 Injection, factor IX, albumin fusion protein (recombinant), Idelvion, 1 IU
J7207 Injection, factor VIII, (antihemophilic factor, recombinant), PEGylated, 1 IU *
J7209 Injection, factor VIII antihemophilic factor, recombinant) (Nuwiq), 1 IU
* Authorization is required

The following HCPCS codes are terminated and no longer billable:

HCPCS code Description
C9137 Injection, factor VIII (antihemophilic factor, recombinant) PEGylated, 1 IU
C9138 Injection, factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 IU

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
blood (2, 3); non ph (10, 11, 22, 23)
Chronic Dialysis Clinics
Pharmacy
blood (2, 3)
Obstetrics
Rehabilitation Clinics
non ph (10, 11, 22, 23)
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6. Updates to the List of Enteral Nutrition Products

The List of Enteral Nutrition Products spreadsheet and the Enteral Nutrition section of the provider manual have been updated to provide policy clarification for the specialty infant extensively hydrolyzed product type and correct the product label name for three Camino Pro products.

The amount reimbursed to providers for contracted enteral nutrition products is the estimated acquisition cost (EAC) listed on the List of Enteral Nutrition Products plus a 23 percent markup.

Listing items is not a guarantee of an item's availability. Product numbers approved on a Treatment Authorization Request (TAR) or Service Authorization Request (SAR) must be the product number dispensed to the beneficiary and the product number claimed for reimbursement by the provider. Billing quantities must be appropriate for the product size (quantity) dispensed and product description on the List of Enteral Nutrition Products spreadsheet. Rounding quantities on claims for enteral nutrition products is not permitted.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
enteral (5, 8, 9, 13, 14, 17)
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7. New ICD-10 Diagnosis Requirements for Removable Foot Insert

Effective retroactively for dates of service on or after October 1, 2015, HCPCS code L3000 (foot, insert, removable, molded to patient model; “UCB” type, Berkeley Shell, each) is reimbursable when billed with ICD-10-CM diagnosis codes G80.0 – G80.2 and G80.4 – G80.9 (cerebral palsy). No action is required by providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess all claims.

Effective for dates of service on or after January 1, 2017, code L3000 is also reimbursable when billed with the following ICD-10-CM diagnosis codes:

G11.1 G24.1 G71.12 Q05.2
G11.9 G24.2 G71.2 Q05.7
G12.0 G60.0 G72.9 Q07.9
G12.1 G60.1 G82.22 Q74.3
G12.8 G61.0 G82.52 Q78.0
G12.9 G70.00 G82.54 Q79.9
G12.20 – G12.22 G70.01 G83.10 – G83.14 R27.0
G12.29 G71.0 G83.9  
G14 G71.11 M33.90  

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

Provider Manual(s) Page(s) Updated
Orthotics and Prosthetics
Pharmacy
ortho (8, 9)
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8. April 2017 Medi-Cal Provider Seminar

The next Medi-Cal seminar is scheduled for April 25 – 26, 2017, 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 Conduent, the Fiscal Intermediary 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 11, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 11, 2017, 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 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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9. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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