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Capitation of Antivirals/Inpatient Admissions Process Change for AIDS MCP

May 23, 2018

Effective for dates of service on or after July 1, 2018, AIDS Healthcare Foundation’s Managed Care Plan (MCP) in Los Angeles County (HCP 915) is responsible for covered and authorized inpatient charges for its enrollees. Hospitals should no longer submit Treatment Authorization Requests (TARs) for inpatient admissions to Medi-Cal. Hospitals should submit an authorization request directly to Positive Healthcare for enrollee inpatient admissions. For assistance with submitting authorizations to Positive Healthcare, providers may call 1-800-474-1434, Monday through Friday, 8:30 a.m. to 5:30 p.m. To verify enrollee eligibility, providers should call Positive Healthcare Member Services at 1-800-263-0067, Monday through Friday, 8 a.m. to 8 p.m.

As a result of this change, effective for dates of service on or after July 1, 2018, providers should no longer bill Medi-Cal fee-for-service for FDA-approved antiviral drugs for recipients enrolled in Positive Healthcare. Providers should bill all FDA-approved antiviral drugs directly to Positive Healthcare. For assistance with filling antiviral prescriptions, providers may call Positive Healthcare Pharmacy Technical Help at 1-888-554-1334, 24 hours a day, 7 days a week.