Previous Medi-Cal Newsroom Articles
- 837 Transaction
- BCCTP
- BIC Update
- Billing
- Budget/Payment Reduction
- Bulletin Announcements
- Cancer Detection Programs
- Child Health and Disability Prevention Program
- Claims
- County Medical Services Program
- DHCS Notice
- Durable Medical Equipment
- Education & Outreach
- eTAR
- Federal Deficit Reduction Act 2005
- Forms
- Internet Professional Claim Submission
- Pharmacy
- POS Device/Network
- Provider Enrollment
- Rate Adjustments
- Telephone Service Center
- Transaction Services
- Women, Infants and Children
837 Transaction
837 Transaction Companion Guide Updates – The 837 Version 4010A1 Health Care Claim Companion Guide has been updated to reflect “Loop 2410” changes required to support collection of the new National Drug Code (NDC) related data fields for Physician Administered Drugs.
Benefits of Submitting Claims Electronically – The 837 transaction is a fast and paper-free alternative to billing on the CMS-1500 and UB-04 hard copy claim forms. (January 2008)
Electronic Attachments for 837 Claims – 837 v.4010A1 claim attachments can now be submitted electronically.
837 Professional Claim Transaction Available on the Medi-Cal Web Site – Did you know that Allied Health, Medical Services (General Medicine and Obstetrics) and Pharmacy providers can submit claims for medical services and supplies using the Medi-Cal Web site?
BCCTP
BCCTP Update – On January 1, 2002, the new Breast and Cervical Cancer Treatment Program (BCCTP) began providing Medi-Cal benefits for the treatment of breast and/or cervical cancer.
BIC Update
SSNs Prohibited: Summer 2007 Implementation – Always Take Your BIC With You notice is now available in multiple languages.
BICs Replacing SSNs Notice – Recipient outreach continues regarding SSN policy change.
Medi-Cal BIC Update – Statewide issuance of new 14-character BICs is now complete.
Billing
Recipient Identifier on Reports and Transactions Sent To Providers – Effective June 2009, providers will uniformly receive on Medi-Cal reports and transactions the provider-submitted recipient identifier sent on the incoming claim reimbursement request and on the claim status inquiry.
Adult Day Health Care Code Conversion Reminder – Effective for dates of service on or after December 1, 2008, the Department of Health Care Services (DHCS) will discontinue the use of Medi-Cal interim codes for Adult Day Health Care services.
TAR Policy Update for Split-Billed MRI or MRA Services – Effective for dates of services on or after August 1, 2008, new guidelines for Treatment Authorization Request (TAR) and electronic TAR (eTAR) submissions apply for split-billed Magnetic Resonance Imaging (MRI) or Magnetic Resonance Angiography (MRA) services.
Blood and Blood Derivatives Code Conversion Reminder – Effective for dates of service on or after August 1, 2008, the Department of Health Care Services (DHCS) discontinued the use of Medi-Cal interim codes for blood products and some services related to administering those products.
Mass Deactivation of Non-Participating Providers and Resulting Effect on NPI Registration – The Department of Health Care Services (DHCS) conducts periodic deactivations of providers that have not billed Medi-Cal for 12 consecutive months and is not required to provide notice to the affected providers.
Deferred TAR Attachment Update – Effective November 15, 2006, attachments for deferred paper TARs will not be returned.
SSN Policy Change Delay – Implementation of new billing requirements that prohibit use of a recipient’s SSN delayed until further notice.
ADHC Update – Effective retroactively to May 1, 2006, new guidelines have been implemented for ADHC providers to clarify number of days and carry-over days.
Reminder to Use Correct Billing Modifiers – Date of service determines the recently implemented modifiers.
Budget/Payment Reduction
June Checkwrite Date Altered – The June 25, 2009 checkwrite payment will be deferred to July 1, 2009 (state’s next fiscal year) for providers who render services for the following programs/services. Deferral of the last June checkwrite will be carried into future years.
Fiscal Year 2008-09 March Payment Hold Update – Pursuant to Chapter 4, Statutes of 2009 (SB 38), reimbursement to Medi-Cal institutional providers, except for small and rural hospitals, designated public hospitals and local education agencies, were held, effective March 26, 2009 (the fourth warrant release date of March).
Medi-Cal Fee-For-Service and Non-Medi-Cal Program Provider Payment Reductions – This notice provides information about pending changes to provider payments for Medi-Cal fee-for-service (FFS) benefits and non-Medi-Cal programs.
CHDP Ten Percent Payment Reduction Update – In accordance with Assembly Bill X3 5, the Department of Health Care Services (DHCS) implemented a 10 percent provider payment reduction for services provided under the Child Health and Disability Prevention (CHDP) program, Medi-Cal and other programs effective for dates of service on or after July 1, 2008.
Medicare Part B Premium Changes – As part of the effort to resolve the severe shortfall in the budget, the Legislature and Governor adopted state law that ends Medi-Cal payments of the Medicare Part B premiums for some Medi-Cal recipients as of November 1.
Distribution of 1099 Tax Forms for Medi-Cal Providers – Medi-Cal providers that registered a different National Provider Identifier (NPI) for each of their legacy provider numbers (also referred to as “sub-parting”) will receive separate 1099 tax forms for each separate provider identifier (NPIs and legacy numbers) used to bill during the 2008 tax year.
Ten Percent Provider Payment Injunction Update – On November 17, 2008, the U.S. District Court issued a new preliminary injunction that requires the Department of Health Care Services (DHCS) to refrain from further reducing payments for home health services and litter van and wheelchair van services, effective for dates of service on or after November 17, 2008.
Update to Payment Reduction for Home Health, Wheelchair and Litter Van Services – Effective for dates of service on or after November 17, 2008, the 10 percent payment reduction is halted for certain home health services, litter van and wheelchair van services.
Use of Social Security Numbers For Billing Prohibited Beginning February 1, 2009 – This notice is to provide information regarding pending changes to provider payments for Medi-Cal fee-for-service benefits and non Medi-Cal programs whose rates are identical to Medi-Cal rates.
Non-contract Hospital Rate Reduction – Recently enacted legislation, AB 1183, the Health Budget Trailer Bill, requires a reduction to the interim payment for inpatient services provided by hospitals that do not participate in the Selective Provider Contracting Program (commonly known as non-contract hospitals), unless the hospitals meet the exemption criteria contained in the bill.
Small and Rural Hospitals Exempt from the Ten Percent Budget Payment Reduction – Effective for dates of service retroactive to November 1, 2008, claims for all Medi-Cal services provided by small and rural hospitals will not be subject to the 10 percent provider payment reduction.
Ten Percent Provider Payment Injunction Update – On September 15, 2008, DHCS received clarification from the Court that the injunction regarding pharmacies includes not only prescription drugs, but also over-the-counter drugs.
Ten Percent Pharmacy Payment Injunction – On July 1, 2008, the Department of Health Care Services (DHCS) implemented a 10 percent payment reduction to providers for various services, including pharmacy, as required by state law.
Provider Payment Reduction for Hospital Inpatient and Some Nursing Facility Services – The Department of Health Care Services (DHCS) is providing this final notice regarding Medi-Cal payment reductions mandated by Welfare and Institutions Code (W & I Code), Sections 14105.19 and 14166.245, which are scheduled to take effect on July 1, 2008.
Medi-Cal Provider Payment Reductions – This notice is to provide information regarding pending changes to provider payments for Medi-Cal fee-for-service benefits and non Medi-Cal programs whose rates are identical to Medi-Cal rates.
2008-09 Fiscal Year State Budget – A list of archived budget related articles.
Status of Provider Reimbursement After Budget Signing – Medi-Cal will process pending claims for payment over the coming weekend.
2007 – 2008 State Budget Reimbursement Contingency– DHCS will direct EDS, an HP company to continue processing claims if the state budget is not signed by June 30.
2004 - 2005 State Budget Signed – The 2004-05 State budget was signed on July 31, 2004.
(updated August 2, 2004)
2003 Budget Act: Provider Payment Reductions – Effective for dates of service on or after January 1, 2004, Medi-Cal will reduce payments for services by five percent.
2003 - 2004 State Budget Reimbursement Contingency – The State budget for fiscal year 2003 - 2004 was not enacted by June 30, 2003. As a result, the Department of Health Care Services (DHCS) has directed EDS, an HP company to implement provisions to continue reimbursing most program’s claims and to withhold reimbursement on claims for programs for which contingency funding is not available.
Bulletin Announcements
Hard Copy Bulletins and Manual Replacement Pages Final Mailing – Due to AB 1183, Chapter 758 (Statutes of 2008), the Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH) had printed and mailed their final hard copy bulletin and manual replacement pages (MRPs) in October 2008.
Bulletin Archives Expanded – Providers can now access 12 months of Medi-Cal Update archives online.
Cancer Detection Programs
Changes to CDP: EWC Data Collection Submission and Case Management Reminder – Cancer Detection Programs: Every Woman Counts (CDP: EWC) Primary Care Providers (PCPs) are reminded about changes to the online program data submission and case management that became effective December 22, 2008.
Breast Feeding-Related Evaluation and Management Services Billing Update – Providers eligible to bill CPT-4 codes 99201 – 99205 (office or other outpatient visit for the evaluation and management of a new patient) and 99211 – 99215 (office or other outpatient visit for the evaluation and management of an established patient) may bill for medically necessary services related to non-routine problems associated with breast feeding using the infant’s Medi-Cal ID number.
Changes to CDP: EWC Data Collection Application – Cancer Detection Programs: Every Woman Counts (CDP: EWC) Primary Care Providers (PCPs) are reminded that effective December 22, 2008, the following changes to the CDP: EWC Data Collection Application will affect how data is submitted online.
CDP: EWC Step-By-Step Provider User Guide – The Cancer Detection Programs: Every Woman Counts Step-By-Step User Guide has been revised with the following.
CDP: EWC Mammography Policy Clarification – Mammography policy stated in Medi-Cal Updates also applies to CDP: EWC with the exception of digital mammography.
Cancer Detection Programs Provider User Guide Update – View a list of updates, including new content, expanded sections and instructions.
Cancer Detection Programs: Every Woman Counts – Providers participating in Cancer Detection Programs: Every Woman Counts can search the entire online recipient database when completing Web data forms, enrolling recipients or re-certifying recipients.
CDP: EWC Step-By-Step Provider User Guide – The Cancer Detection Programs: Every Woman Counts Step-by-Step Provider User Guide is designed to help you navigate the Cancer Detection Programs Application on the Medi-Cal Web site.
Child Health and Disability Prevention Program
Medi-Cal and CHDP Pediatric Obesity Meeting: June 9, 2009 – Learn more and train others. This interactive meeting is designed as a workshop for Medi-Cal providers, Child Health and Disability Prevention (CHDP) providers, and training staff who want to gain additional skills in the identification, prevention, and management of pediatric obesity.
CHDP Electronic Claim Transaction Format Update – The Child Health and Disability Prevention (CHDP) program's proprietary electronic claim transaction formats will be modified to accommodate use of the National Provider Identifier (NPI) and several new fields that have been added to the CHDP Confidential Screening/Billing Report (PM 160) and Confidential Screening/Billing Report Information Only (PM 160 Information Only) claim forms.
New CHDP pre-enrollment process – Effective July 1, 2003, Child Health and Disability Prevention (CHDP) program providers can now pre-enroll children in the Medi-Cal program by using the new CHDP Gateway on either the Medi-Cal Web site or a Point of Service (POS) device.
Claims
Vision Care RAD Code Denials Update – In November 2008, Medi-Cal identified a systems error that resulted in the erroneous denials of Vision Care claims with the following Remittance Advice Details (RAD) codes.
HIPAA Conversion for Non-Physician Medical Practitioner Modifiers – Effective for dates of service on or after February 1, 2009, local Non-physician Medical Practitioner (NMP) modifiers AN, YU, YR and YT will be replaced with national HCPCS and CPT-4 modifiers to comply with HIPAA.
Vision Care Claims RAD Code Denial Updates – Effective July 1, 2006, Medi-Cal implemented important changes to the Vision Care program to be in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Long Term Care (LTC) Provider Overpayment Solution Requires Provider Action – The Department of Health Care Services (DHCS) is finalizing efforts to implement a systematic solution to Medi-Cal claim overpayments made to Long Term Care (LTC) providers.
SCPI Manual Update to OHC Carrier Data – Effective August 25, 2008, the Other Health Coverage (OHC) Carrier Data (C1) 2.1.9 and 3.1.8 record layout specifications will be updated in the Supplemental Claims Payment Information (SCPI) User Guide.
Tamper-Resistant Prescription Pads Requirement Update – Effective April 1, 2008, all written, non-electronic prescriptions must be executed on tamper-resistant pads, in order for Medi-Cal outpatient drugs to be reimbursable by the federal government.
Reminder: Include CMC Attachments with the ACF – The Attachment Control Form (ACF) allows providers to include supporting documentation with their Computer Media Claims (CMC).
CMS-1500 and UB-04 Tutorials Updated with NPI Changes – Effective December 17, 2007, the date of NPI implementation, Medi-Cal providers can use the National Provider Identifier (NPI) for all claims and provider transaction services.
Tamper-Resistant Prescription Pads Requirement – New federal legislation requires that effective April 1, 2008, in order for Medi-Cal outpatient drugs to be reimbursable by the federal government, all written, non-electronic prescriptions must be executed on tamper-resistant pads.
Nine-Digit ZIP Code Encouraged on Claims – As a result of the National Provider Identifier (NPI) implementation, providers should submit a nine-digit ZIP code when entering service address information on claims, effective November 26, 2007. (October 2007)
SCPI Manual Now Available on the Medi-Cal Web Site – The Supplemental Claims Payment Information (SCPI) manual, formerly called the Automated Remittance Data Services (ARDS) manual, was updated in conjunction with the rollout of National Provider Identifier (NPI) numbers.
Inpatient Crossover Claims Update – Effective October 1, 2007, hard copy inpatient crossover claims with certain billing errors will be returned.
New Claim Form Submission Reminders – Guidelines for submitting the new CMS-1500 and UB-04 claim forms.
Claim Form Billing Reminder – Effective June 25, 2007, providers can only submit the new CMS-1500 and UB-04 claim forms.
Printing UB-04 Claim Forms – Requirements to meet the UB-04 print specification.
Special Claims Review FAQs Updated – Updated answers to provider questions about SCR now available.
New Medicare Policy for Dialysis Providers – Effective April 1, 2007, ESRD facilities must bill services separately by service date. (Updated 3/19)
Crossover Claims NPI Update – Register NPI with Medi-Cal before May 23, 2007 to avoid rebilling crossover claims.
Institutional Crossover Claims NPI Error – COBC is implementing a Part A 837 crossover claim system fix.
Institutional Crossover Claims Update – A system fix has been implemented to improve crossover claims processing.
Crossover Claims Urgent Update – Claims Appeal status now available via the PTN and the Medi-Cal Web site.
Claims Appeal Status – Automatic crossover claims blling tips.
Comment Periods for UB-04 and CMS 1500 Claim Forms – Providers are invited to submit comments about UB-04 Claim Form implementation and CMS 1500 claim form changes.
Pre-Checkwrite Review of Claims – Effective for dates of payment on or after July 1, 2004, the Department of Health Care Services (DHCS) has implemented a new process to monitor Medi-Cal claims.
County Medical Services Program
County Medical Services Program: Benefit Update – Effective for dates of service on or after April 1, 2003, County Medical Services Program (CMSP) prescription drug benefits are provided under a contract with MedImpact Healthcare Systems, Inc. (MedImpact), a pharmacy benefit management company.
DHCS Notice
Department of Health Care Services Reorganization – Effective July 1, 2007, certain responsibilities held by the Department of Health Care Services (DHCS) were transferred to the new California Department of Public Health (CDPH).
IUD Investigation Underway – DHCS reviewing records of eight Southern California physicians.
Hurricane Katrina – Evacuees currently enrolled in Medicaid in their home state are eligible for Medi-Cal services
Elimination of Taxpayer-Provided Erectile Dysfunction Drugs for Sex Offenders – See Governor Arnold Schwarzenegger's directive.
Durable Medical Equipment
DME Providers: Billing Assistance and Grace Period for Coding – Specialized assistance for billing issues is now available via the TSC.
DME, O & P and Clinical Laboratory Services Reimbursement Methodology Changes – Effective for dates of service on or after October 1, 2003, reimbursement methodology for Durable Medical Equipment (DME), Orthotic and Prosthetic (O & P) appliances and clinical laboratory services is changed.
Education & Outreach
New Common Denials Tutorial – Effective May 15, 2009, a new tutorial about the most common denial messages providers encounter will be launched on the Medi-Cal Web site.
Medi-Cal Provider Training Survey – The Medi-Cal Education and Outreach team is conducting a training survey to better meet the training needs of the provider community.
RTIP and BCCTP Tutorials Updated – The Real Time Internet Pharmacy Claim (RTIP) and Breast and Cervical Cancer Treatment Program (BCCTP) tutorials have been updated to reflect new program information.
CMS-1500 and UB-04 Claim Form Tutorials Updated – The CMS-1500 and UB-04 claim form tutorials were updated to reflect the most current National Provider Identifier (NPI) information.
New Medi-Cal Training Seminar Registration Tool – Effective December 30, 2008, providers will have the ability to register for Medi-Cal training seminars online. The registration tool will allow providers to register themselves or others.
eTAR Pharmacy Web-based Tutorial – Now available for eTAR Pharmacy NCPDP Internet transactions.
eTAR
Submitting Transportation eTARs – The following is a list of tips and pointers for successfully submitting electronic Treatment Authorization Requests (eTARs) for transportation services.
Submitting Adult Day Health Care eTARs – The following is a list of tips and pointers for successfully submitting Adult Day Health Care (ADHC) electronic Treatment Authorization Requests (eTARs).
Family PACT S-Code Update to eTAR – Previously, when submitting a Family PACT (Planning, Access, Care and Treatment) Program electronic Treatment Authorization Request (eTAR), the ICD-9 Code field required the provider to insert a decimal point when entering a primary diagnosis S-code.
eTAR Tutorials Updated – Effective January 26, 2009 – Effective January 26, 2009 enhancements will be added to the electronic Treatment Authorization Request (eTAR) application to assist users in submitting and updating eTARs correctly.
TAR Submission Requirement for New ADHC HCPCS Level II Code – Treatment Authorization Requests(TARs) that were authorized using the now obsolete HCPCS procedure code Z8500 with a through authorization date on or after December 1, 2008 will not be denied in claims processing.
TAR Submission Requirement for New ADHC HCPCS Level II Codes – Treatment Authorization Requests (TARs) that were authorized using the old Z8500 code with a through authorization date on or after December 1, 2008 will not be denied in claims processing.
Internet Eligibility Inquiry and Spend Down Application Response Update – Effective October 25, 2008, when a recipient’s Social Security Number (SSN) and issue date are submitted on either a Spend Down transaction that certifies eligibility for Medi-Cal benefits or on an Eligibility Inquiry, the “Application Response” page will display the following.
IPCS and RTIP Updates –The Department of Health Care Services (DHCS) recognizes the importance of protecting the identity and the health information of recipients and strongly encourages all providers to avoid using a recipient’s Social Security Number (SSN) whenever possible.
TAR Applications to be Temporarily Unavailable October 11-12, 2008 – Access to the electronic Treatment Authorization Request (eTAR) and National Council for Prescription Drug Programs (NCPDP) Prior Authorization (PA) applications will be temporarily unavailable due to system updates and maintenance starting at 9 a.m. Saturday, October 11, 2008 through 3 p.m. Sunday, October 12, 2008.
Vision Care and Pharmacy Providers Adjudication Response Update – Effective immediately, vision care and pharmacy providers can receive Adjudication Response (AR) notices whether they submit paper or electronic Treatment Authorization Requests (eTARs).
Entering Hospital Days on First Service Line on eTARs – Providers who submit for hospital days on eTARs must enter this information on service line one. Additional procedures should be requested on subsequent service lines to prevent claim submission problems.
Adjudication Response Clarifications for eTAR Providers – Electronic Treatment Authorization Request (eTAR) providers will not receive Adjudication Responses (ARs) unless the service category is either “Pharmacy” or “Vision,” and a valid fax number is included in the Fax Number field.
New Inquire Only Function for TARs – The electronic Treatment Authorization Request (eTAR) Inquire Only functionality for viewing TARs is now available to Medi-Cal providers, including inpatient services providers.
New Fax Option Available for Adjudication Responses (ARs) – Effective July 2007, the Department of Health Care Services (DHCS) implemented the Adjudication Response (AR) in order to reduce the volume of documents containing Protected Health Information (PHI).
TAR Adjudication Response (AR) Notice Update – The Adjudication Response (AR) notice displays Treatment Authorization Request (TAR) service information necessary for submitting claims or responding to requests from the Medi-Cal field office.
Multiple Address Screen eTAR – Upon NPI implementation, select providers will have multiple addresses linked to their National Provider Identifier (NPI). (December 2007)
Attention Providers: Prepare for the Adjudication Response – The Department of Health Care Services (DHCS) will soon discontinue the practice of returning adjudicated paper Treatment Authorization Request (TAR) copies to providers.
Treatment Authorization Request (TAR) Changes – TAR processing changes are being implemented May 1, 2007.
eTAR Available to More Providers – Effective January 15, 2007, eTAR is available for 11 more provider types and services.
eTAR Attachment Guidelines – Guidelines for uploading attachments with eTARs.
ADHC eTAR Submission Option Available – The eTAR Internet application is now available to all ADHC providers.
eTAR Available for Select Providers – The eTAR submission process is now available to 13 more provider types.
eTAR Pharmacy Attachments – New attachment options are available for NCPDP Pharmacy eTARs.
eTAR Pharmacy Web-based Tutorial – Now available for eTAR Pharmacy NCPDP Internet transactions.
Pharmacy eTAR Updates – Fax back response and multiple TAR inquiry now available.
TAR and eTAR Processing Clarification – Providers may not update paper TARs using the eTAR system.
eTAR Available to More Providers – On October 2, 2006, the eTAR submission process was made available to 13 more provider types.
eTAR Submission Guidelines – eTARs submitted for non-benefit services that do not require a TAR will reject and will need to be corrected.
Federal Deficit Reduction Act 2005
Federal Deficit Reduction Act 2005 – Citizenship and Identity Requirements – The August 2007 Medi-Cal Update instructed providers how to help Medi-Cal applicants and beneficiaries meet the citizenship and identity requirements of the federal Deficit Reduction Act (DRA).
Federal Deficit Reduction Act 2005: Employee Education on False Claims Recovery – Effective January 1, 2007, providers must certify that they comply with Section 1902(a) of the Social Security Act.
Federal Deficit Reduction Act 2005 – Medicaid citizenship requirements for California.
Forms
Cutoff Date Extension for Old Claim Forms – Beginning September 17, 2007, claims received on the old HCFA 1500 or UB-92 claim forms will be rejected and returned to the provider.
Reminder: New Proprietary Forms Now Available – New versions of Medi-Cal and Child Health and Disability Prevention (CHDP) proprietary forms are available from Medi-Cal.
UB-04 Claim Form Clarification – For correct use of the UB-04 form for claim submissions, fields 57A through C should be filled out only by “atypical” providers.
Internet Professional Claim Submission
Internet Professional Claim Submission (IPCS) System – The Internet Professional Claim Submission (IPCS) System is now available for submitters with Internet access. This new application was designed for professional medical providers who submit single, professional claims to Medi-Cal.
Pharmacy
DUR Alert System Enhancements – Effective November 1, 2008, Drug Use Review (DUR) alerts for any newly approved drugs or updates to pre-existing drugs (i.e., newly discovered indication, adverse effect, drug-drug interaction, drug-allergy interaction, etc.) will not be generated until new system enhancements are implemented.
Medicare Part D (Federal Prescription Drug Benefit) Update – Beginning January 1, 2006, Medicare Part D, the new federal prescription drug benefit, will pay for prescription drugs for Medicare/Medi-Cal dual-eligible recipients and all other Part D-eligible recipients through private prescription drug plans.
270/271 Version 4010A1 Companion Guide and NCPDP Technical Specifications Updates –The 270/271 Version 4010A1 Health Care Eligibility Benefit Inquiry and Response Companion Guide (Real-Time and Batch Transactions) was updated to reflect the following changes:
Medi-Cal POS NCPDP Pharmacy Transaction Specifications Third Party Vendors (Dial-Up and Leased-Line) Update – The Medi-Cal POS NCPDP Pharmacy Transaction Specifications, Third Party Vendors (Dial-Up and Leased-Line) document has been updated to conform with the National Council for Prescription Drug Programs (NCPDP) standards for the National Provider Identifier (NPI).
Pharmacy TAR (50-1) and eTAR Submission Tips – The following tips have been provided to help make the Treatment Authorization Request (TAR) process for paper and Internet submissions more effective.
Pharmacy Claim Form (30-1) Completion Billing Tips – Providers billing on version 8 of the Pharmacy Claim Form (30-1) should follow the instructions listed below when completing the Metric Quantity fields (Boxes 13, 32, 51 and 70 as applicable). (January 2008)
Application for Enrollment in HIV/AIDS Pharmacy Pilot Project – As previously announced, the Department of Health Care Services (DHCS) is initiating an HIV/AIDS Pharmacy Pilot Project on January 1, 2005. (November 2004)
Pharmacy Update – (last updated 12/16/2002) On April 29, 2002, Medi-Cal upgraded its pharmacy claims processing system to National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard, Version 5.1 for online, real-time submission of pharmacy claims and NCPDP Batch Standard, Version 1.1 for batch submission of pharmacy claims.
POS Device/Network
POS Device Automatic Software Update – Effective mid-December 2008, messages will appear on Point of Service (POS) devices announcing an automatic software update download.
POS Device Automatic Software Update – A software update to POS devices is scheduled for August 25, 2007.
Family PACT Transaction Now Available on the VeriFone Omni 3300 POS Device – The Family PACT (Family Planning, Access, Care and Treatment) transaction is now available on the VeriFone Omni 3300 Point of Service (POS) device. (August 2004)
Provider Enrollment
AB 1226 – Provider Enrollment Forms & Provisions Effective July 1, 2008 – Effective for dates of service on or after July 1, 2008, Welfare and Institutions (W&I) Code, Section 14043.26(b) and (e) allow doctors of medicine and osteopathic physicians who meet specified criteria, and who change their business locations within the same county, to use a “change of location” form.
Provider Enrollment Application Changes Due to NPI – Effective February 15, 2008, in accordance with Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising all provider enrollment application forms to accommodate the National Provider Identifier (NPI).
Assembly Bill 1226 – Provisions Affect All Providers – Effective for dates of service on or after January 1, 2008, Assembly Bill (AB) 1226 has two provisions, that affect all providers, and that amend the laws the Department of Health Care Services (DHCS) uses to review provider applications for participation in the Medi-Cal program.
New Provider Enrollment Forms Requirement – Effective May 23, 2007, only the current versions (dated 3/07) of the provider application forms will be accepted.
Providers Selling or Purchasing a Business – Requirements and procedures for successor liability.
Provider Enrollment Changes – Revised provider enrollment regulations and updated enrollment forms (DHS 6208 and 6210) are available and effective immediately. Applications submitted on earlier versions of the forms and received after February 1, 2003 will be returned to the sender for resubmission.
Rate Adjustments
Speech Generating Devices Reimbursement Increase – Effective for service dates on or after July 30, 2005.
Telephone Service Center
TSC Phone Menu Prompt Options Guide – Save time and get the assistance you need faster by printing this guide and keeping it next to your phone.
Transaction Services
Transaction Service Redesign Now Complete – As of February 25, 2008, the Transaction Services area on the Medi-Cal Web site features a new “look-and-feel” to comply with state-mandated policy and design standards for all California government agency and department Web sites.
Women, Infants and Children
New Formula Contract in the California Women, Infants and Children Supplemental Nutrition Program – Effective August 1, 2003, the California Women, Infants and Children Supplemental Nutrition Program (WIC) is changing infant formula contractors.