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Medi-Cal Update

Heroin Detoxification | October 2020 | Bulletin 553

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1. COVID-19 Quantitative Antibody Test Added as a Medi-Cal Benefit

Effective for dates of service on or after September 8, 2020, CPT® code 86413 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] antibody, quantitative) is added as a Medi-Cal benefit.

CPT code 86413 may be billed with any ICD-10-CM code.

An Erroneous Payment Correction (EPC) will be processed for affected claims.

2. October 2020 HCPCS Quarterly Update

The October 2020 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the October 2020 HCPCS Policy Updates PDF.  Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for the dates of service on or after October 1, 2020. Please refer to the 2020 HCPCS code book for complete code descriptions.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Home Health Agencies/Home and Community-Based Services
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
medi non hcp (2); modif app (13, 26)
Chronic Dialysis Clinics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15)
General Medicine
Clinics and Hospitals
chemo drug a-d (30, 31); chemo drug e-o (20, 29); chemo drug p-z (7–9, 20–23); inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27); ophthal (24); presum bill (12, 14–16); radi dia (21–25); surg digest (7); surg integ (4, 6); surg urin (5, 7)
Heroin Detoxification
Hospice Care Program
Psychological Services
medi non hcp (2)
Local Educational Agency modif app (13, 26)
Obstetrics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27); presum bill (12, 14–16); radi dia (21–25); surg urin (5, 7)
Pharmacy inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); presum bill (12, 14–16)
Rehabilitation Clinics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27)

3. Medi-Cal Business Operations Fiscal Intermediary Name Change

Effective October 1, 2020, providers may notice that the Department of Health Care Services (DHCS) California Medicaid Information System (CA-MMIS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly DXC, LLC, is operating under a new company name, “Gainwell Technologies.” Operations and interactions with providers are not impacted by this FI name change. There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same as well.

4. Fiscal Intermediary Technology Refresh Implementation

As previously announced in a July 16, 2020 article, DXC Technology, the Business Operations Fiscal Intermediary (FI), has staged the deployment of various business oriented IT solutions to occur July 2020 onward.

As of August 2020, the following technological refreshes have already been implemented:

  • Print and Mail – Print and mailing solution for outbound communications, including provider welcome packets and provider letters

  • Member Card – Member card production solution for Beneficiary Identification Card (BIC) and Health Access Program (HAP) card production

  • Learning Management System – Also known as the Medi-Cal Learning Portal (MLP), this solution manages and houses training for internal and external users (e.g. providers, billers)

On September 14, 2020, the remaining technological refreshes are scheduled to be live in production:

  • Imaging/Optical Character Recognition (OCR) – Enables the processing of paper documents, including paper Treatment Authorization Requests (TARs), paper claims and correspondence

  • Records Repository – Houses the scanned images of paper documents received, including provider correspondence, claims and attachments

  • Telecommunications Infrastructure – Structure required to support the call platform and telephony solutions required for customer service call center operations

  • Customer Relationship Management – Provider and member contact ticketing solution used to manage, track and measure customer service

  • Interactive Voice Response – Voice response solution used to support provider self-service features, including the Automated Eligibility Inquiry Verification (AEVS) and the Provider Telecommunications Network

  • Medi-Cal Subscription Services (MCSS) – Provider/external party solution used to communicate information, such as System Status Alerts, news articles and provider manual updates

As with the initial operational transition in October 2019, and the first wave of technical changes in August 2020, the primary objective is a successful transition without disruption to state programs, providers and/or members (beneficiaries). Given the type of IT services slated for the second wave of technological changes, providers and members may notice differences in processes and/or may experience longer call wait times pre- and post-implementation as the operations prepare for deployment and stabilize.

The Department of Health Care Services (DHCS) will continue to provide updates as this effort progresses. Please continue to monitor the Medi-Cal Provider website for future updates on this topic.

5. July 2020 NCCI Updates with Announced Correction

The Centers for Medicare and Medicaid Services (CMS) updated payment policy as part of the National Correct Coding Initiative (NCCI) Quarterly Updates for July 2020. The mandatory national edits were incorporated into the Medi-Cal claims processing system and were effective for dates of service on or after July 1, 2020.

Upon release, the Medically Unlikely Edit (MUE) values and MUE Adjudication Indicators (MAI) were inaccurate for the following HCPCS codes. CMS issued replacement MUE Quarter 3 2020 files for Practitioners (PRA) and Outpatient providers (OPH) retroactive to July 1, 2020.

  • G2078 (take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled opioid treatment program)

  • G2079 (take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled opioid treatment program)

Providers may refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website for information.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

6. Administrative Hearings to be Conducted by Telephone or Video Conference

The Office of Administrative Hearings and Appeals (OAHA) will conduct informal reviews, pre-hearing matters, settlement conferences, formal hearings and other matters via telephone or video conference, while Executive Orders N-55-20 and N-63-20 are in effect. The Department of Health Care Services (DHCS) recently issued guidance on timeframe extensions and data submittal deadlines for audits, and updates to administrative hearing timelines and processes, available on the DHCS website. For questions regarding this guidance, please email the OAHA inbox at OAHAmailbox@dhcs.ca.gov.

7. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective October 1, 2020
NDC Labeler Code Contracting Company's Name
11788 AIPING PHARMACEUTICAL, INC.
42667 ACERUS PHARMACEUTICALS CORPORATION
69751 EVOFEM BIOSCIENCES, INC.
69880 CHIASMA, INC
69967 ARISE PHARMACEUTICALS LLC
70868 KEY THERAPEUTICS, LLC
72677 VIELA BIO, INC.
73302 HRA PHARMA AMERICA, INC.
73535 MORPHOSYS US INC.
Terminations, effective October 1, 2020
NDC Labeler Code Contracting Company's Name
00029 GLAXOSMITHKLINE
00091 SCHWARZ PHARMA, INC.
10511 PHOTOCURE, INC.
10888 BANNER PHARMACAPS INC.
13632 ROSEMONT PHARMACEUTICALS, LTD.
15127 SELECT BRAND DISTRIBUTORS
24856 THROMBOGENICS INC.
31357 INSPIRE PHARMACEUTICALS, INC.
43773 SLATE PHARMACEUTICALS, INC.
53097 THE PHARMA NETWORK, LLC
63717 HAWTHORN PHARMACEUTICALS
70403 ARU PHARMA INC.
70752 QUAGEN PHARMACUETICALS LLC
71717 MEGALITH PHARMACEUTICALS INC.

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (2, 5–8, 10, 17–22)

8. Medi-Cal Rx Portal Registration Launched for Pharmacy Providers and Prescribers

The Department of Health Care Services (DHCS) continues to make significant towards a successful transition of pharmacy services on January 1, 2021 to Medi-Cal Rx.

To help facilitate a smooth and effective transition for Medi-Cal providers, beneficiaries, and other interested parties, DHCS has taken proactive steps to deploy a robust and multi-faceted outreach campaign, which includes, developing comprehensive beneficiary notices, developing call center scripts, conducting targeted provider outreach and providing for and advertising publicly various training opportunities available starting in October and continuing through the end of the year.

Additional activities include developing a dedicated Medi-Cal Rx website with secure portal components for Medi-Cal providers, health plans, beneficiaries and other interested parties.

Recently, DHCS launched the dedicated Medi-Cal Rx secure web portal, https://medi-calrx.dhcs.ca.gov/home/, and a registration page for Medi-Cal provider access, including but not limited to physician prescribers and pharmacies. This registration is the first step in the process for pharmacies and prescribers to use the Medi-Cal Rx secure web portal andits web-based tools for pharmacy services. For detailed registration and training instructions, access the Medi-Cal Rx Web Portal and Training Registration article located on the Pharmacy News Page (https://medi-calrx.dhcs.ca.gov/provider/pharmacy-news).

Access to the Medi-Cal Rx secure web portal will include key functions such as:

  • Web Claims Submission, Activities, and Inquiries

  • Beneficiary Eligibility Look Up

  • Prior Authorization Information and Submission

Other functions within the Web Portal include:

  • Learning Management System (LMS) for pharmacy and prescriber trainings

  • Message Center

  • Provider Survey

  • Password Management

  • Secure Chat

DHCS reminds Medi-Cal providers, health plans, beneficiaries and other interested parties that it is very important registration be completed early so user training and access are complete and active by January 1, 2021. Doing so will help to remove any potential challenges for successful utilization of the Medi-Cal Rx secure web portal.

The entire dedicated Medi-Cal Rx website will be fully operational by January 1, 2021. In the meantime, DHCS encourages Medi-Cal pharmacy providers and prescribers, health plans, beneficiaries, and other interested parties to sign up for the Medi-Cal Rx Subscription Service, which allows interested parties to receive Medi-Cal Rx updates in near real-time by email.

For general project questions and/or comments, please visit the DHCS website or email RxCarveOut@dhcs.ca.gov. In addition, DHCS encourages stakeholders to review the Medi-Cal Rx Frequently Asked Questions (FAQ) document, which continues to be updated as the project advances.

9. National Correct Coding Initiative Quarterly Update for October 2020

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 dates of service on or after October 1, 2020.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

10. Get the Latest Medi-Cal News: Subscribe to MCSS Today

The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.



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