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

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.

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

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

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

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

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

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

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

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

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.

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.

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.

2023 HCPCS Quarter 1 Update.

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.

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.

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

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

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

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

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

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.

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

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

Implementation is delayed for CPT code 99463.

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

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.

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.

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

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