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Medi-Cal News Articles

Title

Category

Publish Date

Address Validation Requirement for Submitters

Submitters will be prompted to validate their mailing addresses when logging into Transactions Services.

DHCS Notice

01/27/2023

Crossover Billing Information for Medicare Providers Serving People with Both Medicare and Medi-Cal

Physicians do not need to be contracted with the Medi-Cal plan’s network to submit a bill to the Medi-Cal plan for any Medicare cost sharing. Patients may continue to see their current physicians even if they join a Medi-Cal plan.

Billing

01/25/2023

Update: Incontinence Product List Medi-Cal Benefit

Updated information for HCPCS code T4536 and UPNs products as Medi-Cal benefits.

Pharmacy

01/24/2023

Lassen County Added to the Medi-Cal County Inmate Program

For date of services from 7/1/2022 through 6/30/2023, Lassen County is added to process claims under the MCIP.

Billing

01/23/2023

Continuity of Care for Transitioning Medi-Cal Members

Medi-Cal members that are transitioning into Medi-Cal Managed Care have continuity of care protections.

DHCS Notice

01/13/2023

Expanded Use of Bivalent Dosages Approved for Children Six Months and Up

Bivalent dose for Pfizer-BioNTech (third dose) and Moderna (booster) COVID-19 vaccine is approved for children as young as six months.

COVID-19

01/13/2023

Clinical Trials Policy Update

Effective retroactively for claims with DOS on or after 7/1/2022, Medi-Cal will cover patient care costs in clinical trials.

Forms

01/11/2023

PHE Telehealth Policy Clarification for Medication Abortion Update: HCPCS Code S0199

DHCS will allow a timeliness waiver as a result of policy clarification for HCPCS code S0199.

DHCS Notice

01/09/2023

Coming Soon: New HACCP Provider Manual Section

New provider manual section for the Hearing Aid Coverage for Children Program (HACCP).

Programs

01/09/2023

Updated Telehealth, ASW and AMFT Instructions for FQHCs/RHCs, Tribal FQHCs and IHS-MOAs

Update to telehealth and virtual telephonic communications for FQHCs/RHCs, Tribal FQHCs and HIS-MOAs.

Billing

01/06/2023

Telehealth Flexibilities and Revisions to the Telehealth Provider Manual

The Telehealth Provider Manual is updating and providers are reminded that telehealth flexibilities that were made for COVID-19 will end when the Public Health Emergency is federally-declared ended.

COVID-19

01/06/2023

EOMB/MRN Not Required for IHS-MOA and Tribal FQHC Providers Billing LMFT Services

An Explanation of Medicare Benefits (EOMB)/Medicare Remittance Notice (MRN) is not required for Licensed Marriage and Family Therapist (LMFT) services billed by Indian Health Services – Memorandum of Agreement or Tribal Federally Qualified Health Centers providers.

Billing

01/06/2023

Intimate Partner Violence Screening and Referrals Survey for Medicaid Primary Care Clinicians

The Office of Evaluation and Inspections is conducting a study on challenges faced by primary care clinicians related to intimate partner violence screening and referrals. The survey is voluntary, and clinicians’ responses will be anonymous.

DHCS Notice

01/05/2023

2023 HCPCS Quarter 1 Update

2023 HCPCS Quarter 1 Update.

HCPCS

12/30/2022

Reminder: Billing Tips for Recipients Restricted to Emergency Services

Providers billing claims for recipients restricted to pregnancy, post-partum and/or emergency services are reminded of how to properly indicate an emergency service on the CMS-1500 and UB-04 claim forms.

Billing

12/30/2022

CMC Plans No Longer Covered in CCI Counties

Article to inform providers that effective for dates of service on or after January 1, 2023 CMC Plans no longer provide services to Cal MediConnect beneficiaries residing in specified counties.

Billing

12/30/2022

UnitedHealthcare Community Plan of California no Longer a Medi-Cal MCP in San Diego County

The UnitedHealthcare Community Plan of California is no Longer a Medi-Cal Managed Care Plan (MCP) in San Diego County.

Programs

12/29/2022

CalAIM Mandatory Managed Care Enrollment Transition Phase II

Phase II of the CalAIM initiative will standardize enrollment processes for mandatory managed care enrollment effective January 1, 2023.

Billing

12/28/2022

Senior Care Action Network (SCAN) Health Plan Expansion

Effective for dates of services on or after January 1, 2023, Senior Care Action Network (SCAN) Health Plan will be expanding services.

DHCS Notice

12/28/2022

Bebtelovimab No Longer Authorized to Treat COVID-19

Effective for DOS on or after 11/30/2022, codes M0222, M0223 and Q0222 are no longer benefits.

COVID-19

12/27/2022

EWC Primary Care Provider and Referral Provider Billing Reminder

Every Woman Counts Primary Care Providers (PCPs) and referral providers are reminded to verify certification date and ID number to avoid claim denials.

Billing

12/27/2022

Long Term Care Skilled Nursing Facility Services

Effective for dates of service on or after January 1, 2023, recipients who receive institutional Long Term Care (LTC) services in a Skilled Nursing Facility (SNF) will be able to enroll or continue enrollment in Medi-Cal Managed Care in all counties.

DHCS Notice

12/27/2022

TAR Requirement Removal and FDA Approvals for Veklury

Effective for DOS on or after 3/1/2023, a TAR is no longer required for Veklury.

COVID-19

12/23/2022

Save the Date: Provider Portal Coffee Breaks

Medi-Cal will host upcoming coffee breaks in March and April for the new Provider Portal.

DHCS Notice

12/23/2022

Implementation Delay: New Benefit for Same Day Newborn Admission and Discharge

Implementation is delayed for CPT code 99463.

Billing

12/22/2022

Coming Soon: Expanded Use of Bivalent Dosages Approved for Children 6 Months and Up

Bivalent dose for Pfizer-BioNTech (third dose) and Moderna (booster) COVID-19 vaccine is approved for children as young as six months.

COVID-19

12/20/2022

National Correct Coding Initiative Quarterly Update for January 2023

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are effective for claims received on or after January 1, 2023.

Claims

12/16/2022

Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines

Medi-Cal is now accepting claims for the administration of the booster dose of Novavax and Pediatric Bivalent Pfizer-BioNtech and Moderna COVID-19 vaccines.

COVID-19

12/16/2022

Monkeypox Vaccines and Laboratory Test Added as Family PACT Benefits

Monkeypox vaccines and testing are now benefits under Family Planning, Access, Care and Treatment (Family PACT) program.

Family PACT

12/16/2022

Multipurpose Senior Services Program Untimely Submission Claims Denials

Impacted Multipurpose Senior Services Program providers are given a timeliness extension until March 31, 2023, for select claims.

Claims

12/16/2022

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