Source: http://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/part1201903.asp
Timestamp: 2019-03-26 04:58:45
Document Index: 502646940

Matched Legal Cases: ['art 1', 'art 1', 'art 1', 'art 1', 'art 1', 'art 1']

Medi-Cal: Medi-Cal Update - Part 1 - Program and Eligibility | March 2019
Medi-Cal Update - Part 1 - Program and Eligibility | March 2019"); ifrm_doc.write("
Part 1 - Program and Eligibility | March 2019
Claims for Noncapitated Antivirals for HCP 915 Erroneously Denied
Name Change for Select HCPs in Los Angeles and San Diego Counties
Certain Paper Enrollment Applications Removed from the Medi-Cal Website
Postponement of AIDS MCP Psychiatric Drug Changes
Rebinyn Added as Noncapitated Benefit for Select MCPs
Disulfiram Available as Noncapitated Benefit for Select MCPs
AEVS: Carrier Codes for Other Health Coverage: March 2019 Update
2. Claims for Noncapitated Antivirals for HCP 915 Erroneously Denied
From January 1, 2019, through January 15, 2019, claims for noncapitated antiviral drugs for recipients enrolled in AIDS Healthcare Foundation's Managed Care Plan (MCP) in Los Angeles County (HCP 915) for dates of services on or after January 1, 2019, erroneously denied with Remittance Advice Details (RAD) code 0037: Health Care Plan enrollee, capitated service not billable to Medi-Cal.
Treatment Authorization Requests (TARs) for these services submitted to Medi-Cal from January 1, 2019, through January 15, 2019, may also have erroneously denied. Providers should resubmit denied TARs.
The claims processing issue has been resolved. An Erroneous Payment Correction (EPC) will be implemented to reprocess erroneously denied claims.
3. Name Change for Select HCPs in Los Angeles and San Diego Counties
Effective for dates of service on or after January 1, 2019, the names of select Managed Care Plan (MCP) Health Care Plans (HCPs) are changed.
The Caremore Cal MediConnect plan in Los Angeles County (HCP 818) is now known as Anthem Blue Cross Cal MediConnect.
The Care 1st Partner Plan, LLC Cal MediConnect plans in Los Angeles County (HCP 817) and San Diego County (HCP 803) are now known as Blue Shield of California Promise Cal MediConnect.
The Geographic Managed Care (GMC) plan in San Diego County (HCP 167) is now known as Blue Shield of California Promise Plan.
Addresses and telephone numbers for these plans have not changed. Providers may contact the HCPs for assistance and information at the following numbers:
Anthem Blue Cross Cal MediConnect – (888) 350-3447
Blue Shield of California Promise Cal MediConnect – (855) 905-3825
Blue Shield of California Promise Plan – 1-800-605-2556
Part 1 mcp code dir (7, 16); mcp gmc (3)
4. Certain Paper Enrollment Applications Removed from the Medi-Cal Website
As specified in a previous Provider Enrollment Division (PED) provider bulletin published January 4, 2019, on November 18, 2016, the Department of Health Care Services (DHCS) instituted a web-based Medi-Cal provider enrollment system entitled Provider Application and Validation for Enrollment (PAVE) 2.0 and on September 4, 2018, instituted PAVE 3.0. PAVE provides a new mode of submitting provider enrollment applications and required documentation to DHCS by means of an electronic form, the Medi-Cal Provider e-Form Application (e-Form).
With the implementation of the PAVE provider portal, the following paper enrollment applications are removed from the Medi-Cal website:
Crossover Only Provider Form (MC 0804)
Drug Medi-Cal Provider Agreement (DHCS 6009)
Drug Medi-Cal Substance Use Disorder Clinic Application (DHCS 6001)
Medi-Cal Change Of Location Form For Individual Physician Or Individual Dentist Practices Relocating Within The Same County (DHCS 9096)
Medi-Cal Clinical Medical Laboratory Application (DHCS 6204)
Medi-Cal Clinic-Based Certified Nurse Midwife Application (DHCS 6204)
Medi-Cal Director/Licensed SUD Treatment Professional/SUD Nonphysician Medical Practitioner (DHCS 6010)
Medi-Cal Durable Medical Equipment Provider Application (DHCS 6201)
Medi-Cal Group Designation of Delegated Officials Form (DHCS 5263)
Medi-Cal Non-physician Medical Practitioner and Licensed Midwife Application (DHCS 6248)
Medi-Cal Ordering/Referring/Prescribing Provider Application/Agreement/Disclosure Statement For Physician and Non-physician Practitioners (DHCS 6219)
Medi-Cal Orthotics and Prosthetics Provider Application (DHCS 6202)
Medi-Cal Pharmacy Provider Application (DHCS 6205)
Medi-Cal Physician Application/Agreement (DHCS 6210)
Medi-Cal Provider Agreement (DHCS 6208)
Medi-Cal Provider Application (DHCS 6204)
Medi-Cal Provider Group Application (DHCS 6203)
Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216)
Medi-Cal Rendering Provider/Group Affiliation/Disaffiliation Form (DHCS 4029)
Out-of-State Provider Express Enrollment (MC 4603)
Part 1 prog (11); prov guide (3 – 7)
Rehabilitation Centers non ph (3, 8, 20)
5. Postponement of AIDS MCP Psychiatric Drug Changes
This article corrects information published in the December 2018 Medi-Cal Update, titled “Capitation of Select Psychiatric Drugs for AIDS MCP.” The previous article announced that changes regarding the capitation of the following psychiatric drugs for AIDS Healthcare Foundation’s Managed Care Plan (MCP) in Los Angeles County (HCP 915) would be effective for dates of service on or after January 1, 2019:
These changes have been postponed. No changes to the capitation of psychiatric drugs for Health Care Plan (HCP) 915 have occurred. These, therefore, remain non-capitated. The date on which these policy changes will become effective will be announced at a later date. Providers are encouraged to routinely check for updates on the Medi-Cal website for the forthcoming notice of implementation.
6. Rebinyn Added as Noncapitated Benefit for Select MCPs
Effective for dates of service on or after April 1, 2019, Injection Factor IX (antihemophilic factor, recombinant), glycopegylated, (Rebinyn), 1 IU is a noncapitated benefit for select Managed Care Plans (MCPs). This coagulation factor is indicated for the treatment of hemophilia B in children and adults and is used for:
On-demand treatment and control of bleeding episodes, or
Part 1 mcp cohs (10); mcp gmc (10); mcp imperial (8); mcp prim (6); mcp two plan (9)
7. Disulfiram Available as Noncapitated Benefit for Select MCPs
Effective for dates of service on or after April 1, 2019, disulfiram is available as a noncapitated benefit for the treatment of alcoholism for all Managed Care Plans (MCPs) except for the following Health Care Plans (HCPs):
8. AEVS: Carrier Codes for Other Health Coverage: March 2019 Update
D035 MODA/DELTA DENTAL OF OREGON
H183 HUMANA VALUE/GOLD PLUS