23-1411 See What News Is Online for November 2023
Date: 12/08/23
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The table below outlines communications posted in the Provider Library in November 2023. The table includes the posting date, material number and title, type of notice, applicable audience and counties, and a summary of the communication.
Date, Number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
November 3, 2023 23-1181m, Providers Must Meet Medi-Cal In-Person Referral Requirement for Telehealth | Regulatory | Physicians PPGs
| Medi-Cal Molina | Clarifies the requirements for referral and facilitation of in-person care when telehealth services are available. |
November 6, 2023 23-1270m, For Family Planning Services, Provider Augmented Reimbursement Now Based on Medi-Cal FFS Rate | Regulatory | Physicians PPGs Hospitals Ancillary provider CM providers CS providers | Medi-Cal Molina
| Informs providers that family planning augmented reimbursement required by All Plan Letters (APLs) 10-003 and 10-014 was retired on August 15, 2023. The updated reimbursement rate will revert to the Medi-Cal fee-for-service rate. |
November 6, 2023 23-1285m, Stay Informed With the Fall 2023 Provider Pulse Newsletter | News & Announcements | Physicians PPGs | Medicare (Wellcare By Health Net) | The Fall 2023 issue of the quarterly Provider Pulse newsletter is available online, including instructions on how to access it. Highlights from this issue include the Medi-Cal expansion to ages 26-49 regardless of immigration status, national NCQA accreditation (for Medicare only) and several stories about the company’s philanthropic activities across the state. |
November 6, 2023 23-1282m, Stay Informed With the Fall 2023 Provider Pulse Newsletter | News & Announcements | Physicians PPGs | IFP (HMO/PPO) Medi-Cal | |
November 14, 2023 23-1338m, Medical Policies – October 2023 | Contractual | Physicians PPGs Hospitals Ancillary providers | IFP (HMO/PPO) Medi-Cal Medicare (Wellcare By Health Net) | Notifies providers about changes to existing medical policies and a retired policy for October 2023. 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. |
November 16, 2023 23-1321m, Help Protect Infants with Nirsevimab at No Cost through VFC Program | News & Announcements | Hospitals | Medi-Cal Molina
| Notice to hospitals, specifically birthing and pediatric hospitals, that Nirsevimab will soon be available through the California Vaccines for Children (VFC) Program at no cost. Hospitals serving Medi-Cal members are encouraged to enroll in the VFC program to help save costs on this drug. |
November 17, 2023 23-1265m, Findhelp How-To Guide for Providers and Community Partners | Contractual | Physicians PPGs Hospitals Ancillary providers | IFP (HMO/PPO) Medi-Cal Molina Medicare (Wellcare By Health Net) | Providers and community partners can refer to this notice to learn how to access the findhelp guide to assist members with no-cost and low-cost services based on a member’s ZIP Code. The guide outlines information on how to use findhelp along with submitting referrals for services. |
November 30, 2023 23-1349m, Your Role in Following the False Claims Act | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | IFP (HMO/PPO) Medi-Cal Medicare (Wellcare By Health Net) | Informs providers of their responsibilities in following the requirements of the False Claims Act. |
1 ECM – Enhanced Care Management; CS – Community Supports
2 Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the provider portal.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.