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All Communities - Latest News

Medi-Cal News Articles

Title

Category

Publish Date

Sending EWC Paper Claims to the Correct Address

Providers are reminded to mail claims to the CAMMIS FI. Claims submitted to the EWC Office will not be processed.

Every Woman Counts

10/22/2021

FQHC/RHC Annual Rate Adjustment Correction

DHCS posted a bulletin informing FQHCs and RHCs of a 1.4 percent rate increase to reflect the current MEI. These rates were erroneously updated at 1.9 percent and being corrected.

Billing

10/21/2021

COVID-19 Uninsured Group Program Off-Premise Flexibilities

PE providers are allowed to complete determinations for COVID-19 PE, off the premises of hospitals and clinics. They may also use third-party vendors to help complete applications.

COVID-19

10/21/2021

Reminder Flowcharts Must Accompany TARs Submitted for Therapeutic Anti-Decubitus Mattresses and Bed Products

All initial and reauthorization Treatment Authorization Requests (TARs) for support surfaces must be accompanied by the appropriate flowchart(s) found in the Therapeutic Anti-Decubitus Mattresses and Bed Products section of the Medi-Cal Provider Manual.

eTAR and TAR

10/20/2021

Filing Window: Marriage and Family Therapist Visits for FQHC/RHC Providers

Newsflash to alert providers of a timely filing window for marriage and family therapist visits for FQHC/RHC providers. Retroactively for dates of service January 1, 2018 through July 12, 2021.

Billing

10/15/2021

Extension of Grace Period Related to Four Walls Requirement for IHS/Tribal Facilities

The grace period previously granted to Indian Health Service (IHS) and Tribal facilities related to the “Four Walls” Requirement is extended to conclude nine months after the end of the COVID-19 Public Health Emergency (PHE).

COVID-19

10/15/2021

MCSS Emails and MLP Surveys Temporarily Suspended

MCSS provider notifications, as well as MLP Surveys, are down as of 5 p.m. on October 15, 2021.

DHCS Notice

10/15/2021

FQHC/RHC Annual Rate Adjustment

FQHCs and RHCs Prospective Payment System reimbursement rates increased.

Rates

10/12/2021

Medi-Cal Rx Pharmacy Providers Electronic Fund Transfer Set Up and Opt Out

Pharmacy

10/11/2021

Updated Policy for Palivizumab for the 2021-2022 RSV Season

Policy update for Palivizumab for the 2021–2022 RSV Season.

Billing

10/08/2021

Erroneous Family PACT Denials for Same Day Billing of Evaluation and Management and Education and Counseling Codes

The Department of Health Care Services is aware of claim denials occurring when providers attempt to bill an E&M code with an E&C code on the same date of service and is actively working on a solution.

Billing

10/08/2021

Coming Soon: Booster Dose for Pfizer-BioNTech COVID-19 Vaccine is Authorized for Certain Populations

The Food and Drug Administration amended the Emergency Use Authorization for the Pfizer BioNTech COVID-19 vaccine to allow for use of a single booster dose for certain populations.

COVID-19

10/08/2021

Medi-Cal Rates Adjustment

2021 Medi-Cal Rates Landing Page Update

Rates

10/07/2021

Reminder Claim Status and Adjudication Guidance

Reminder of claims status and adjudication guidance for providers.

Claims

10/06/2021

Sessions Available for the November Virtual Claims Assistance Room Event

Provider virtual event for one-on-one billing assistance.

Outreach and Education

10/04/2021

New FCCU FAQs and, Updated Medi-Cal Contact Page

New FCCU FAQs and Contact page update.

DHCS Notice

10/01/2021

Correction: CFTR Gene Analysis Diagnosis Codes

Correction of the ICD-10-CM diagnosis codes for CPT code 81220.

Billing

10/01/2021

Certain September 2021 IPCS Claims Erroneously Processed

A few IPCS claims were incorrectly processed between September 18, 2021 and September 22, 2021. Affected claims will be rectified.

Claims

09/29/2021

New Public Health Order requires workers in adult and senior care facilities and in-home direct care settings to be vaccinated by November 30

Workers who provide care to Medi-Cal beneficiaries must receive the first dose of a one-dose vaccine regimen, or the second dose of a two-dose regimen, by November 30, 2021.

COVID-19

09/28/2021

Update Erroneously Denied Claims for Vaccines Billed Using SK and SL Modifiers

Claims

09/28/2021

Tracheostomy Supplies Updates Now Implemented

Delayed updates to the List of Contracted Tracheostomy Supplies now implemented.

Pharmacy

09/24/2021

Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Can Be Processed

Medi-Cal can now accept Medical and Outpatient claims for the administration of a third dose of an applicable COVID-19 vaccine.

COVID-19

09/21/2021

Supplemental Rate for Administration of COVID-19 Vaccine in Home Setting

Medi-Cal will reimburse providers an additional $35.00 per dose when administering a COVID-19 vaccine in the home of a Medi-Cal beneficiary unable to travel to a vaccination site.

COVID-19

09/21/2021

Shared Nursing TT Modifier Billing Issues Are Being Addressed

DHCS is working to resolve issues with Shared Nursing ‘TT Modifier’ billing.

Billing

09/21/2021

Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Authorized for Certain Populations

The Food and Drug Administration has amended the Emergency Use Authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines to permit the administration of a third dose to certain individuals with compromised immune systems.

COVID-19

09/21/2021

Implementation Delays for Tracheostomy Supplies Updates

Implementation of updates for tracheostomy supplies has been delayed and providers are instructed to hold resubmission.

Billing

09/17/2021

National Correct Coding Initiative Quarterly Update for October 2021

The Centers for Medicare & Medicaid Services (CMS) has incorporated the quarterly National Correct Coding Initiative (NCCI) Q4 2021 payment policy update into the Medi-Cal claims processing system.

Claims

09/16/2021

2022 ICD-10-CM/PCS Codes Update

CMS modifications to ICD-10-CM and ICD-10-PCS long and short descriptions for 2022.

ICD-10

09/15/2021

Frequency Limit Updated for Evaluation and Management Service

The frequency limit for CPT code 99417 is updated from 10 units to 4 units.

HCPCS

09/08/2021

Updated: TAR Criteria for AIIR Services

Weekly acute rehabilitation therapy hours reduced for AIIR services.