24-1052 Provider Communications Posted Online and Operations Manual Updates for September 2024
Date: 10/07/24
Access the Provider Library for the latest operational and Plan updates and changes to better service your patients
The tables below outline provider communications posted online and operations manual changes made in September 2024.
- Communications posted online: Includes the posting date, material number and title, type of notice, applicable audience and lines of business, and a summary of the communication.
- Provider operations manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name (and path to section where document is located), audience, affected lines of business and URLs, and a summary of the change.
- Behavioral Health Provider Operations Manual: Includes the effective date of the change, operations manual section, topic and summary of the change.
View recent health advisories and notices online
As a reminder, you can access summaries of recent health advisories from public health agencies and/or other organizations to help promote awareness among your staff at Public Health Advisories & Notices. View the page today to read about recent recommendations from the Centers for Disease Control and Prevention for Hepatis C (HCV) testing for those who are pregnant, and infants and children exposed to HCV.
Communications posted online in September 2024
Date posted | Number and title | Type of notice | Audience | Lines of business1 | Summary |
9/3/24 | 24-916m, Keep Your Demographic Information Current with Symphony and Other Resources | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Keep your demographic information updated via Symphony and other alternative online form options. This flyer includes direct links for accessing these options, as well as required time frames for submitting changes. |
9/3/24 | 24-917m, Keep Your Demographic Information Current with Symphony and Other Resources | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | Medicare Advantage HMO/PPO | Keep your demographic information updated via Symphony and other alternative online form options. This flyer includes direct links for accessing these options, as well as required time frames for submitting changes. |
9/6/24 | 24-945m, Balance Billing for Medi-Cal Members is Prohibited | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | Balance billing is prohibited for Medi-Cal members, per regulatory requirements. This notice includes examples of prohibited balance billing and other guidelines to ensure compliance. |
9/11/24 | 24-958m, Improve the Members’ Experience with Care Coordination | News & Announcements | Physicians Ancillary providers Behavioral Health providers
| IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Reminder about the importance of timely information exchange to improve care coordination and member outcomes. Tips and best practices are included. |
9/16/24 | 24-943m, How to Make Sure Your Claims Aren’t Rejected | News & Announcements | PPGs | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Review tips and best practices for digital and paper claims to avoid rejections, along with contacts and payer identification numbers for submitting claims electronically. |
9/17/24 | 24-955m, Changes to Pharmacy Administration Reimbursement for ACIP-Recommended Vaccines | Regulatory | Physicians PPGs
| Medi-Cal (all counties) Molina | As of 8/1/24, pharmacies will be reimbursed for administering Advisory Committee on Immunization Practices (ACIP)-recommended vaccines under Medi-Cal Rx or can bill Health Net under a member’s medical benefit. This change, retroactive to 1/1/23, ensures that ACIP-recommended vaccines are covered without member cost-share and no prior authorization. |
9/20/24 | 24-1000m, Medical Policies – August 2024 | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Review changes to medical policies for procedures and services for Aug. 2024. Medical policies, available online at Health Net Medical Policies, offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
9/26/24 | 24-1047m, No-Cost Accredited Provider Training to Enhance Your Skills in Suicide Prevention | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | No-cost suicide prevention training available online. Enroll today to earn 1.50 continuing education credits and help save lives in the communities we serve. |
9/27/24 | 24-1007m, Resources to Help Patients Reduce and Control Asthma Symptoms | News & Announcements | Physicians PPGs | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Learn about treatment options that may help reduce patients’ asthma exacerbations. Includes available resources on asthma management and prevention. |
9/30/24 | 24-961m, Want Healthy Patients? Recommend the Flu Vaccine | News & Announcements | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Use this tip sheet to learn about updates for the flu vaccine for 2024-2025 and for tips on how to encourage patients to get the vaccine and protect their health during the flu season. |
9/30/24 | 24-962m, Want Healthy Patients? Recommend the Flu Vaccine | News & Announcements | Physicians PPGs
| Medicare HMO/PPO | Use this tip sheet to learn about updates for the flu vaccine for 2024-2025 and for tips on how to encourage patients to get the vaccine and protect their health during the flu season. |
1Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.
Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in September 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
9/11/24 | Health Industry Collaboration Effort (ICE): Provider Tools to Care for Diverse Populations (under Forms and References) | Physicians PPGs Hospitals Ancillary | This toolkit assists providers by sharing a variety of information on language assistance programs and different cultures to help them care for a diverse population. | |
9/26/24 | Telehealth Billing Requirements (under Claims and Provider Reimbursement) | Physicians PPGs Hospitals Ancillary | HMO, PPO, Medi-Cal, Medicare | Added information on how to use appropriate CPT and HCPCS codes that are most descriptive for telehealth services. |
9/30/24 | Monitoring Provider Sanctions for the Federal Employees Health Benefit Program (under Provider Oversight) | PPGs |
| Updated document to include how Health Net and PPGs must monitor, terminate, and review claims for suspended and debarred providers to ensure they aren’t paid or credentialed. |
Behavioral Health Provider Operations Manual (PDF) changes in September 2024
Effective Date | Section | Topic | Summary |
9/1/24 | Section 2: Important Contacts | Important Contacts |
Updated contact information for provider inquiries and provided billing instructions/references for accurate claim submissions. |
9/1/24 | Section 12: Billing and Reimbursement | Billing and Reimbursement |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.