24-1181 Provider Communications Posted Online and Operations Manual Updates for October 2024
Date: 11/07/24
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The tables below outline provider communications posted online and operations manual changes made in October 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.
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Check out the fall issue for details on how we are working to support you, your patients and your community. Some topics in this issue include:
- Find Provider Training and Onboarding Resources More Easily on Our Consolidated Site
- Californians’ Health Care in Good Hands Thanks to Community Health Centers
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in October 2024
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
10/11/24 24-1094m, Safeguard Patient Privacy When Sharing Medical Records | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | Reminder about protecting patient privacy when sharing medical data. |
10/9/24 24-1090m, Use Updated Templates to Notify Members of Specialist Terminations | Regulatory | Physicians PPGs Behavioral Health providers | Medicare Advantage HMO/PPO | Updated letter templates, approved by the Centers for Medicare & Medicaid Services, must be used to notify members of a specialist’s termination. The required templates are posted in the Forms & References section in the Provider Library. |
10/16/24 24-1107m, Medical Policies – September 2024 | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Review changes to medical policies for procedures and services for Sept. 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. |
10/18/24 24-895m, How You Code Vascular Conditions Impacts Risk Adjustment | News & Announcements | PPGs
| Medicare Advantage HMO/PPO | This new online training, available at Provider Training Webinars under Operational, Administration and Value-Added Provider Trainings, can help PPGs improve clinical documentation to support accurate coding of vascular diseases. It also covers how documentation and coding impact risk adjustment. |
10/18/24 24-1016m, Medication Trend Updates and Formulary Changes – 4th Quarter 2024 | Contractual | Physicians PPGs | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Information about drug list and formulary changes and medication safety issues for the fourth quarter of 2024. |
1 Medi-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 October 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
10/3/24 | Member Notification for Specialist Termination (under Provider Oversight > Facility and Physician Additions) | Physicians PPGs Hospitals Ancillary |
| Updated document to describe updated letter templates that provider groups are required to use to notify members of a specialist’s termination. |
10/23/24 | Multiple documents updated due to a change to the health and wellness programs | Physicians PPGs Hospitals Ancillary | Benefits
Quality Improvement
| The Decision Power program is no longer offered and all references in provider operations manual and the Provider Library (including relevant Contacts) were updated to “health and wellness” or “health and wellness programs, including Sharecare,” where applicable. |
Behavioral Health Provider Operations Manual changes in October 2024
Effective Date | Section | Topic | Summary |
10/15/24 | Section 3.6 Credentialing: Administrative Guidelines | Types of Termination | Updated section to describe updated letter templates that provider groups are required to use to notify members of a specialist’s termination. |
Provider Services
Line of business | Phone number | |
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medi-Cal (including CS and ECM providers) | N/A | |
Behavioral Health providers | N/A |
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.