24-453 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 in April 2024.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience, 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 (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 Medi-Cal > Provider Pulse Newsletter.
Communications posted online in April 2024
Date, number and title | Type of notice | Audience1 | Summary |
|---|---|---|---|
4/11/24 24-294m, Use ECM to Improve Care for People Experiencing Homelessness | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | 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. |
4/22/24 24-396m, Use the Most Descriptive SDOH Z Codes on Claims and Encounters | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | 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 24-402m, Medical Policies – March 2024 | Regulatory | Physicians PPGs Behavioral Health providers | Review medical policies updates for March 2024. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online 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 24-406m, Updated Service Codes for IHA | News & Announcements | Physicians PPGs
| 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. |
1 ECM – Enhanced Care Management; CS – Community Supports
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in April 2024
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
4/1/24 |
(under Member Rights and Responsibilities) | Physicians PPGs Hospitals Ancillary | Added reference to the Community Health Plan of Imperial Valley PCP/PPG Change form, which members use to request a primary care physician (PCP) change. |
4/10/24 | Payment Integrity Policies
| Physicians PPGs Hospitals Ancillary | 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 |
(under Appeals, Grievances and Disputes) | Physicians PPGs Hospitals Ancillary | 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.
This information applies to Medi-Cal in Imperial county.