24-1184 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 communication, applicable audience and counties, and a summary of the communication.
- Medi-Cal Provider Operations Manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name, path to section where document is located, URLs, audience 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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- CalViva Health Achieves NCQA Health Plan Accreditation
- Find Provider Training and Onboarding Resources More Easily on Our Consolidated Site
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Communications posted online in October 2024
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
10/11/24 (updated – please see summary) 24-853m, 2023 Provider Appointment Availability and After-Hours Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers Behavioral Health providers | Fresno Kings Madera | This notice was originally posted on 9/19/24, and was included in provider update 24-1055 distributed on 10/7/24. It informed providers about 2023 results for the Provider Appointment Availability and After-Hours Access Survey. Please note, the online communication was updated on 10/11/24 to indicate that the Plan met all standards except for those indicated in the notice. |
10/11/24 24-1092m, Safeguard Patient Privacy When Sharing Medical Records | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | Reminder about protecting patient privacy when sharing medical data. |
10/16/24 24-1109m, Medical Policies – September 2024 | Contractual | Physicians PPGs Behavioral Health providers | Fresno Kings Madera | Review changes to medical policies for procedures and services for Sept. 2024. Medical policies, available online at 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 24-1017m, Medication Trend Updates and Formulary Changes – | Contractual | Physicians PPGs | Fresno Kings Madera | Information about Medi-Cal drug list changes and medication safety issues for the fourth quarter of 2024. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in October 2024
Effective Date | Document name, URL and path (if applicable) | Audience | Summary |
|---|---|---|---|
10/3/24 | Member Notification for Specialist Termination (under Provider Oversight > Facility and Physician Additions) | Physicians PPGs Hospital 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 |
(under benefits) | Physicians PPGs Hospital Ancillary | The Decision Power program is no longer offered and all references in the Medi-Cal Provider Operations Manual were updated to show “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 |
|---|---|
CalViva Health Medi-Cal (including CS and ECM providers) | |
Behavioral Health providers |
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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.