24-451 Provider Communications Posted Online and Operations Manual Updates for April 2024
Date: 05/07/24
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The tables below outline provider communications posted online and operations manual changes made in April 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: No changes were made to this manual in April 2024.
Read the latest issue of the spring Provider Pulse newsletter
Check out the spring issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- Health Net Funding Helps Create Black Birth Justice Coalition to Address Pregnancy-Related Conditions
- Medi-Cal Expansion Means “All Are Welcome”
- California Launches Free Video Series to Help Parents and Caregivers Address Parenting Challenges
- As Rain Battered California – Health Net Provided Help
- California Students Find New Hope and Friendships on No One Eats Alone® Day
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in April 2024
Date, number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
4/11/24 24-293m, Use ECM to Improve Care for People Experiencing Homelessness | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) | Learn how to tailor Enhanced Care Management (ECM) services to meet the needs of individuals and families experiencing homelessness. Download a recent Population of Focus Spotlight published by the Department of Health Care Services, which describes how to enhance care for this vulnerable population. |
4/12/24 24-338m, Complete the Special Needs Plan Model of Care Training | News & Announcements | Physicians PPGs Hospitals Ancillary providers
| Medicare Advantage HMO/PPO
| Informs providers of the annual Model of Care training that must be completed by December 31, 2024. |
4/22/24 24-395m, Use the Most Descriptive SDOH Z Codes on Claims and Encounters | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | Clarifies how to apply the Department of Health Care Services’ social determinants of health (SDOH) codes on claims and encounters to prevent denials. Resources from the Centers for Medicare & Medicaid Services are included for reference. |
4/30/24 24-403m, Medical Policies – March 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 March 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 can be accessed at bit.ly/HN_med_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. |
4/30/24 24-405m, Updated Service Codes for IHA | News & Announcements | Physicians PPGs | Medi-Cal (all counties) Molina | Find out how to access and download a tip sheet from the Provider Library with updated service codes for completing initial health appointments. The tip sheet also includes helpful tips, requirements and best practices. |
4/30/24 24-432m, Submit Claims With Valid National Drug Codes to Ensure Payment | News & Announcements | Physicians PPGs Hospitals Ancillary providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) | Reminder: Providers must adhere to the National Drug Codes (NDCs) billing requirements and ensure submitted claims with NDCs have all required information for timely claims processing. Claims without this information cannot be paid. |
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 April 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
4/10/24 | Payment Integrity Policies
| Physicians PPGs Hospitals Ancillary providers | Payment policies have been removed from the provider operations manual and are now available on the Health Net provider website at Payment Policies. | |
4/17/24 | Peer-to-Peer Review Requests (under Appeals, Grievances and Disputes) | Physicians PPGs Hospitals Ancillary providers | New document added to inform providers of guidelines for requesting peer-to-peer reviews. Providers are specifically advised that they have five business days after issuance of an adverse prior authorization determination to request a peer-to-peer review. |
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.