24-1256 Provider Communications Posted Online and Operations Manual Updates for November 2024
Date: 12/06/24
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 November 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: No changes were made to this manual for November 2024.
Communications posted online in November 2024
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
11/8/24 24-1163m, Complete Mandatory Training, Get Prop 56 Payments | Regulatory | Physicians PPGs
|
| Learn how you can earn rewards for screening members for adverse childhood experiences (ACEs). |
11/12/24 24-1191m, Medical Policies – October 2024 | Contractual | Physicians PPGs Behavioral Health providers |
| Review changes to medical policies for procedures and services for October 2024. Medical policies, available online at Medical policies page 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. |
11/20/24 24-1207m, Annual Medical Records Collection Begins January 2, 2025 | News & Announcements | Physicians PPGs |
| Informs providers of the upcoming annual medical record collection. Medical records will be reviewed to ensure providers are complying with the HEDIS® Clinical Effectiveness of Care measures. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in November 2024
Effective Date | Document name, URL and path (if applicable) | Audience | Summary |
11/18/24 | Language Assistance Program and Cultural Competency (under Quality Improvement) | Physicians PPGs Hospital Ancillary | Updated links to the Interpreter Services form under “Provider Responsibilities” and renamed title of form. |
11/18/24
| Access to Interpreter Services (under Contacts) | Physicians PPGs Hospital Ancillary | Updated contact information for providers to access no-cost interpreter services. |
11/19/24 |
(under Quality Improvement)
| Physicians PPGs
| Updated following reference documents:
|
11/25/24 | Claims Processing for DSNP in EAE Counties (under Claims and Provider Reimbursement)
| PPGs | Updated information to reflect that, for D-SNP members, PPGs must review both Medicare and Medi-Cal benefits to determine eligibility for services requested and not deny prior authorization as “not a covered benefit” without checking both Medicare and Medi-Cal covered services. Includes updates to prior authorization timelines for such services and how to submit a secondary claim. |
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.