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New Managed Care Payment Process Upcoming for IHS-MOA

December 26, 2017

The Department of Health Care Services (DHCS) is committed to implementing a new payment process for Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics providing services to Medi-Cal managed care beneficiaries. Effective for dates of service on or after January 1, 2018, IHS-MOA clinics will no longer submit Medi-Cal managed care claims for services covered by Medi-Cal managed care plans (MCPs). This includes claims for Medicare enrollees also enrolled in a Medi-Cal MCP. IHS-MOA clinics will receive full, per-visit reimbursement from the MCPs for timely claim submission. With the implementation of the new process, IHS-MOA clinics are no longer required to submit claims for the MCP differential rate. Claims submitted with code set 520 T1015 SE for dates of service on or after January 1, 2018, will be adjudicated at a $0 payment.

All other claims – dental, Medi-Cal fee-for-service, carve-out managed care (services not covered by the MCP), Medicare crossover, and Capitated Medicare Advantage Plan (for members not enrolled in a Medi-Cal MCP) – will continue to be adjudicated per current processes.