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Medi-Cal Update

Part 1 - Program and Eligibility | May 2022

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1. Remittance Advice Detail Code 010: Denials for Duplicate Claims

A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between hospitals and nursing homes during the transfer of the recipient. Providers see this on their Remittance Advice Details (RADs) as a claim denied by RAD code 010.

Should the denied provider choose to dispute the claim and there is no resolution between the two providers regarding the dates in question, Medi-Cal could recoup the full reimbursement of the original erroneously paid claim, and will not make an adjustment without a correction request from that provider.

Incorrectly paid and denied claims can also create incorrect provider reimbursement data and inaccuracies in the health service records that may impact beneficiary share of cost, access to services and estate recovery.

For assistance in resolving these issues, providers are advised to write to the Correspondence Specialist Unit at:

Correspondence Specialist Unit
P.O. Box 13029
Sacramento, CA 95813-4029

For information about proper claim form completion, refer to the claim completion section in the appropriate Part 2 manual.

2. Medi-Cal Subscription Service is Coming Back

++An article titled “Medi-Cal Subscription Service (MCSS) is Live” is now posted to the News Flash area of the Part 1 Provider Communications section of the Medi-Cal website. Refer to this article for the most recent status of and instruction regarding MCSS.

Overview

The Department of Health Care Services (DHCS) is pleased to announce that the Medi-Cal Subscription Service (MCSS) is returning.

For providers and Medi-Cal stakeholders unfamiliar with the service, MCSS is a free service that sends subscribers subject-specific emails based on the provider communities they have subscribed to. This keeps subscribers up-to-date when urgent announcements and other updates post to the Medi-Cal Providers website.

DHCS took the service down in October 2021 to address some necessary changes. The returning MCSS retains the functionality and look-and-feel of the service subscribers are familiar with. However, DHCS wishes to highlight one change and one action required of subscribers to ensure they receive MCSS emails once the service is turned back on:

  • Sent From Email Changed: Emails received via MCSS will be sent from the following email address: do-not-reply_MCSSCalifornia@gainwelltechnologies.com.

  • Subscriber Action: The first few messages from MCSS may appear in spam or promotional inboxes. To avoid this, and to ensure they receive the latest messages from Medi-Cal fee-for-service, subscribers are instructed to add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their list of approved senders. Note that the exact instructions on how to add an email to the list of approved senders, will change depending on the email client in use. Medi-Cal has identified some frequently used email domains and resources on how to manage an approved senders list:

  • Subscribers who have alternative email domains not listed above (for example, @companyname.com), should defer to their company’s IT group or the email provider they use for their business, to ensure MCSSCalifornia@gainwelltechnologies.com is listed as an approved sender.

  • Without taking action to add MCSSCalifornia@gainwelltechnologies.com to the list of approved senders, it is possible that MCSS messages will either be blocked from the subscriber’s account or be filtered into Spam/Promotional folders.

Returning MCSS Subscribers

DHCS recommends existing subscribers add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their approved sender list to resume receiving MCSS emails. This is the only action needed. You do not need to re-subscribe for MCSS. Subscribers should keep an eye out for a “Welcome Back” email in the near future to see if they have appropriately added do-not-reply_MCSSCalifornia@gainwelltechnologies.com to the approved senders list.

DHCS will not send MCSS emails for publications published between October 2021 and May 2022. Instead, the “Welcome Back” email will highlight major changes and point to additional resources on any missed updates. Medi-Cal apologizes for any inconvenience this may cause.

Existing Subscribers can update their subscription preferences through a link in the footer of MCSS emails they receive. Only the most recent MCSS email will properly update subscription preferences.

New MCSS Subscribers

New subscribers can either sign up now using the current MCSS Subscription Form, or when MCSS returns using the updated online form. New subscribers using the current MCSS Subscription Form will not receive any emails until MCSS returns and the “Welcome Back” email is sent. New subscribers who sign up when MCSS returns will receive a “Welcome to MCSS” email. New subscribers should add do-not-reply_MCSSCalifornia@gainwelltechnologies.com to their approved senders list.

What’s Next

A News article will be published on the Medi-Cal Providers website once MCSS and MLP surveys are officially brought back online, and the “Welcome Back” emails begin to be sent out. DHCS is projecting that this will occur in late May or early June 2022.

Additionally, for all MCSS subscribers, refer to the updated Med-Cal Subscription Service (MCSS) Help page to find more information about this service.

3. Medi-Cal Checkwrite Schedule Updated for June 2022

Effective retroactively for dates of service on or after July 1, 2021 for fiscal year 2021-2022, the checkwrite schedule has been updated to include additional dates for June 2022 as follows:

California MMIS
Fiscal
Intermediary Files
Received by SCO
File Release to
Bank/Funding
SCO Mails Warrants, EFT
Advice Statements and
No-Pays
EFT Settlement
Date
June 27, 2022 June 28, 2022 June 30, 2022 June 30, 2022

Additionally, the electronic fund transfer (EFT) settlement date has been updated for the following cycle:

California MMIS
Fiscal
Intermediary Files
Received by SCO
File Release to
Bank/Funding
SCO Mails Warrants, EFT
Advice Statements and
No-Pays
EFT Settlement
Date
June 13, 2022 June 16, 2022 June 16, 2022 June 21, 2022
Note: End of quarter payments, warrants and EFT payments are paid in the same quarter month. Funding (federal draw down) must occur on or before noon on Tuesday (preferred by close of business on Monday). Files to US Bank will be released on September 28, 2021, December 29, 2021 and June 28, 2022 respectively.
Provider Manual(s) Page(s) Updated
Part 1 check (2, 3)

4. Humboldt County is a Participating County for MCIP Services

Effective for dates of service on or after July 1, 2021, through June 30, 2023, Humboldt County is a participating county for Medi-Cal County Inmate Program (MCIP) services.

Complete information is available on the Medi-Cal State Inmate Program and Medi-Cal County Inmate Program page of the Department of Health Care Services (DHCS) website.

For additional information, providers may submit questions to DHCSIMCU@dhcs.ca.gov.

5. AEVS: Carrier Codes for Other Health Coverage: May 2022 Update

The AEVS: Carrier Codes for Other Health Coverage list has been updated. These codes are updated monthly. Additions and deletions are shown between the start and end change brackets on the updated provider manual pages. Updates are listed below.

Additions

AEVS Code Carrier
A073 Aetna Medicare Value Plan (IL)
A074 AllCare Advantage Focus Rx
A075 Amerivantage Plus
A077 Aetna Medicare Eagle Plan
A080 Aetna Advantra
B011 Blue Cross Medicare Advantage
B013 BluePathway Plan 1
B014 BSW SeniorCare Advantage
B016 Blue Advantage Complete
C025 Cigna Preferred Medicare
F003 Friday Health Plans
H438 HumanaChoice (TX)
H439 HealthSun SunPlus Advantage Fl
H440 Humana Community HMO
H441 HumanaChoice (NC)
K006 Kaiser Senior Advantage (HI)
O001 Optimum Gold Rewards Plan
S013 SelectHealth Advantage
U016 UnitedHealthcare Medicare
W085 Wellcare No Premium Open

6. Medi-Cal Suspended and Ineligible Provider List is Updated

The monthly-updated Medi-Cal Suspended and Ineligible Provider List (S&I List) is available on the Suspended and Ineligible Provider List page of the Medi-Cal website.

Always refer to the S&I List when verifying ineligibility. Eligibility or ineligibility must also be verified through the Health and Human Services (HHS) Federal Office of Inspector General (OIG) List of Excluded Individuals/Entities.

Suspension of Entities Submitting Claims for Suspended Providers
Entities submitting claims for services rendered by a health care provider suspended from Medi-Cal or excluded from Medicare or Medicaid by the OIG are subject to Medi-Cal suspension.

Welfare and Institutions Code (W&I Code), section 14043.61, subdivision (a), states, in relevant part, that “a provider shall be subject to suspension if claims for payment are submitted under any provider number used by the provider to obtain reimbursement from Medi-Cal for the services, goods, supplies or merchandise provided, directly or indirectly, to a Medi-Cal recipient by an individual or entity that is suspended, excluded, or otherwise ineligible because of a sanction to receive, directly or indirectly, reimbursement from Medi-Cal and the individual or entity is listed on either the Medi-Cal Suspended and Ineligible Provider List or any list published by the Federal Office of Inspector General regarding the suspension or exclusion of individuals or entities from the Federal Medicare and Medicaid programs, to identify suspended, excluded, or otherwise ineligible providers.”

7. Medi-Cal Hotlines


Medi-Cal Hotlines

Border Providers 1-916-636-1200
DHCS Medi-Cal Fraud Hotline 1-800-822-6222
Telephone Service Center (TSC) 1-800-541-5555
Provider Telecommunications Network (PTN) 1-800-786-4346

For a complete listing of specialty programs and hours of operation, refer to the Medi-Cal Directory in the provider manual.

Mailing Address:
California MMIS Fiscal Intermediary
PO Box 13029
Sacramento, CA 95813-4029

Medi-Cal Fraud is Against the Law

Medi-Cal fraud costs taxpayers millions each year and can endanger the health of Californians. Help protect Medi-Cal and yourself by reporting violations today.

DHCS Medi-Cal Fraud Hotline: 1-800-822-6222

The call is free and you can remain anonymous. Knowingly participating in fraudulent activities can result in prosecution and jail time. Help prevent Medi-Cal fraud.

Stop Illegal Tobacco Sales

The simplest way to stop illegal tobacco sales to persons under the age of 21 is for merchants to check ID and verify the age of the tobacco purchasers. Report illegal tobacco sales to 1-800-527-5443. For more information, see the California Department of Public Health – California Tobacco Control Program website.

Free Smoking Cessation Resources

The California Smokers’ Helpline provides free help for quitting smoking in multiple languages. Services can be accessed via toll-free hotline 1-800-NO-BUTTS, text, online chat or mobile app. For more information, see the California Smokers’ Helpline website.



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