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
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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