20-801 Change to Financial Responsibility for Diagnostic Testing

Date: 10/09/20

This information applies to Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Effective January 1, 2021, the DOFR will be updated

Diagnostic testing that is done in-home will follow the same Division of Financial Responsibility (DOFR) risk as diagnostic testing done in an outpatient facility. An example may include medically necessary home sleep tests for all members, including those who may be at risk for untreated sleep apnea. Conducting home sleep tests could provide safety for your patients at this time.

Participating physician groups (PPGs) that have Diagnostic Testing in an Outpatient Facility as their risk in the DOFR are financially responsible for diagnostic testing at home. This includes:

• Facility/Technical Component AND
• Professional Component

The DOFR will be updated with this change effective January 1, 2021.

Additional information

Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CalViva Health at 1-888-893-1569.