24-308 Provider Communications Posted Online and Operations Manual Updates for March 2024
Date: 04/05/24
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 in the Provider Library in March 2024. After selecting the applicable line of business on the left-hand side, you can view the following.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience, 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, path to section where document is located and URL for the document; audience; and a summary of the change.
- Behavioral Health Provider Operations Manual: No changes were made to this manual in March 2024.
Communications posted online in March 2024
Date, Number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
3/12/24 24-202m, Protect Abortion Care: Physician Assistants Allowed to Provide Reproductive Health Care | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) Molina | Informs providers about Senate Bill 385, Physician Assistant Practice Act: abortion by aspiration: training, which was updated to align abortion training to physician assistants and clears pathways for physician assistants to meet requirements to perform aspiration abortions. The bill also protects health care providers from facing penalties for performing abortion care services. |
3/12/24 24-195m (PDF), Update Your Demographic Information Without Logging In | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina |
Reminder: Use the simple instructions in this flyer to update your demographic information online and see what else the Plan does to collect contact information so members can find you in our provider directories. |
3/12/24 24-197m (PDF), Update Your Demographic Information Without Logging In | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medicare Advantage HMO/PPO
| |
3/22/24 24-254m, Use These Vendors for Supplemental Benefits | Contractual | Physicians PPGs Hospitals Ancillary providers | Medicare Advantage HMO/PPO
| Informs providers of updated contact information for vendors who provide supplemental benefits for members enrolled in Wellcare By Health Net plans. |
3/29/24 24-285m, Medication Trend Updates and Formulary Changes – Second Quarter 2024 | Contractual | PPGs Hospitals
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) Molina | Find out about recent pharmacy trend updates and formulary changes for the second quarter of 2024. This includes a safety alert from the Food and Drug Administration about a rare but serious drug reaction to select antiseizure medicines. |
3/29/24 24-277m (PDF), Medical Policies – February 2024 | Regulatory | Physicians PPGs Behavioral Health providers
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina |
Notifies providers about changes to medical policies for February 2024. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services. IFP (Ambetter HMO and PPO, Employer Group (HMO/POS, PPO) and Health Net Medi-Cal 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. |
3/29/24 24-275m, Medical Policies – February 2024 | Regulatory | Physicians PPGs Behavioral Health providers | Medicare Advantage HMO/PPO
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3/29/24 24-281m, Join Us for a Webinar on 2024 Medicare Risk Adjustment Model Changes | News & Announcements | Physicians | Medicare Advantage HMO/PPO
| Informs providers of the upcoming webinar on the topic of CMS-HCC risk adjustment changes and 2024 ICD-10 clinical modification updates. |
1 ECM – Enhanced Care Management; CS – Community Supports
2 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 March 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
3/5/24 | Hospital and Inpatient Facility Discharge Planning (under Utilization Management) | PPGs Hospitals Ancillary |
| Updated to inform providers on the requirements of the seven-day post discharge follow up and provide details about the Transitional Care Services program. |
3/13/24 | Non-Contracting Provider Payment Disputes (under Appeals, Grievances and Disputed > Provider Appeals and Dispute Resolution) | PPGs
|
| Updated the CMS Claims Dispute Resolution Uphold and Overturn template letters with the correct Medicare Provider Disputes address. Delegated PPGs must use these letters to advise non-contracting providers to contact the Plan if they disagree with the PPG’s decision. |
3/22/24 | Contacts
| Physicians PPGs Hospitals Ancillary | Medicare
| Updated contact information for vendors who provide supplemental benefits for members enrolled in Wellcare By Health Net plans. |
3/26/24 | Responsibility for Inpatient Concurrent Review and Transfer for Transplant Evaluation (under Benefits > Transplants) | Physicians PPGs Hospitals Ancillary |
| Updated to clarify for delegated entities that members who are inpatient and are transferred to another facility for a transplant evaluation does not change delegated entities’ utilization management and risk responsibility. |
Behavioral Health Provider Operations Manual changes in March 2024
Effective Date | Section | Topic | Summary |
|---|---|---|---|
3/1/24 | Utilization Management - Higher Levels of Care | Procedures > Concurrent Review | Added language to reflect specific requirements that discharge summaries be submitted within 24 hours of discharge. |
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.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.