23-1125 See What News Is Online for September 2023
Date: 10/06/23
Go to the Provider Library for the latest information that can help you do business with us
The table below outlines communications that have been posted in the Provider Library in September 2023. It includes the posting date, material number and title, type of communication, applicable audience and counties, and a summary of the communication.
Date, number and title | Type of notice | Audience1 | Counties | Summary |
|---|---|---|---|---|
September 1, 2023 23-970m, Reminder: Medi-Cal Overpayment to Providers Must Be Recovered and Returned | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | Fresno Kings Madera | This is a reminder regarding Medi-Cal overpayments made by Health Net. It outlines providers’ responsibilities to report and return any overpayment within 60 calendar days. |
September 5, 2023 23-973m, Updates to Medi-Cal Covered Services Offered Through Telehealth | Regulatory | Physicians PPGs
| Fresno Kings Madera | Provides clarification on Medi-Cal covered services offered through telehealth and the expectations related to documentation for telehealth. |
September 7, 2023 23-981m (PDF), Updates to Prop 56 Directed Payments for Developmental Screening Services | Regulatory | Physicians PPGs Hospitals Ancillary providers | Fresno Kings Madera | Notifies providers that the Proposition 56 payment of $59.90 for each qualifying developmental screening claim submitted for dates of service on or after |
September 8, 2023 23-951m (PDF), Follow These Guidelines for BHT for Medi-Cal Members Under Age 21 | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | Fresno Kings Madera | Provides guidance on the provision of medically necessary behavioral health treatment (BHT) services for members under the Early and Periodic Screening, Diagnostic, and Treatment benefit. Requirements can be reviewed in the Department of Health Care Services (DHCS) All Plan Letter (APL) 23-010, Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21. |
September 14, 2023 23-1023m (PDF), Reminder: Sign This Form for NEMT for Medi-Cal Members | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers
| Fresno Kings Madera | This is a reminder to sign and return a Physician Certification Statement (PCS) form to Modivcare when Medi-Cal members need non-emergency medical transportation. The form is included with this notice or can be downloaded using the instructions provided. |
September 25, 2023 23-1087m (PDF), 2022 Provider Appointment Availability and After-Hours Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers | Fresno Kings Madera | Informs providers of the Provider Appointment Availability and After-Hours Access Survey results for 2022. Results are used to monitor provider compliance with timely access and after-hours regulations, and evaluate the effectiveness of the network to meet the needs and preferences of members. |
September 26, 2023 23-990m (PDF), Take Online Training to Get Paid for Screening for ACEs | Regulatory | Physicians PPGs
| Fresno Kings Madera | Informs providers about training and directed payments for adverse childhood experiences (ACEs) screening services for adults (through age 64) and children. Requirements can be reviewed in DHCS APL 23-017, Directed Payments for Adverse Childhood Experiences Screening Services. |
September 27, 2023 23-1102m (PDF), Submit Clean Claims or Encounters to Receive Payment for Pregnancy Termination Services | Regulatory | Physicians PPGs Ancillary providers | Fresno Kings Madera | Informs providers on: 1) how to avoid processing delays; 2) the list of information that should be part of an inquiry or dispute and where to send it; and 3) where to find information about clean claims or encounters related to pregnancy termination services, as required by DHCS APL 23-015, Prop 56 Directed Payments for Private Services. |
September 28, 2023 23-932m (PDF), Update Your Demographic Information Without Logging In | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | Fresno Kings Madera | This is a reminder for providers to keep their data current in our online provider directories. It includes instructions for updating demographic information online. Current information enables members to find them when searching for a provider. |
September 28, 2023 23-1115m (PDF), Updates to Proposition 56 Directed Payments for Physician Services | Regulatory | Physicians PPGs Ancillary providers | Fresno Kings Madera | This provides information related to Proposition 56 directed payments for specific physician services, as required by DHCS APL 23-019, Proposition 56 Directed Payments for Physician Services. It includes: 1) a list of information that should be part of an inquiry or dispute and where to send it; 2) where to find information about clean claims or encounters; and, 3) the rate table with service dates for specific physician services that are eligible for supplemental payments. |
September 29, 2023 23-1118m (PDF), Medical Policies - 3rd Quarter for July and August 2023 | Contractual | Physicians PPGs Hospitals Ancillary providers | Fresno Kings Madera | This medical policy notice for July and August 2023 includes: 1) a new medical policy; 2) changes to existing policies; 3) clinical practice guideline updates; and, 4) inactive or replaced policies. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at bit.ly/HN_med_policies. As a reminder, all services must be medically necessary and member benefits, legal and regulatory mandates take precedence over content of medical policies and must be applied first. |
1 ECM – Enhanced Care Management; CS – Community Supports
Additional information
If you have additional questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.