20-928 Notice of Correction for 20-801, Change to Financial Responsibility for Diagnostic Testing

Date: 11/12/20

This information applies to Participating Physician Groups (PPGs)

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

Help patients stay safe with in-home sleep studies during COVID-19

Some sleep studies are done in home to help ensure patients safely get medically necessary sleep tests. An example is the risk of untreated sleep apnea.

Whose financial risk is it?

To clarify, sleep studies done in home follow the same Division of Financial Responsibility (DOFR) risk category as an outpatient facility.

Participating physician groups that have Diagnostic Testing in an Outpatient Facility as their risk in the DOFR are financially responsible for diagnostic tests at home. This includes the technical and professional component.

This does not require a change to the DOFR on January 1, 2021 as communicated in provider update 20-801, distributed on Friday, October 9, 2020.

Additional information

Providers are encouraged to access the provider portal online 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, conta ctCalViva Health at 1-888-893-1569.