24-676 Provider Communications Posted Online and Operations Manual Updates for June 2024
Date: 07/05/24
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The tables below outline provider communications posted online and operations manual changes made in June 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: Includes the effective date of the change, operations manual section, topic and summary of the change.
Communications posted online in June 2024
| Date, number and title | Type of notice | Audience1 | Lines of business2 | Summary |
6/18/24 24-556m, HIP Incentive | News & Announcements | Physicians | Medi-Cal (all counties) Molina | The HEDIS® Improvement Program offers a $75 incentive to Medi-Cal primary care physicians for confirming pregnancies, ensuring timely prenatal care and completing and returning the Confirmation of Pregnancy form. |
6/20/24 24-610m, | News & Announcements | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health | Medi-Cal (all counties) Molina | Physicians and other providers are encouraged to let pregnant and postpartum Medi-Cal members know about the benefits of doula services. Doula assistive and support services are available before, during and after pregnancy. Also remind members about Mahmee maternal support services and how to register. |
6/20/24 24-636m, | Contractual | Physicians PPGs Behavioral | IFP Employer Medi-Cal (all counties) Molina | Notice about changes to existing medical policies for procedures and services for May 2024. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at Medical 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. |
6/26/24 24-647m, Enhanced ACE_78A | News & Announcements | PPGs Hospitals | IFP Employer Medi-Cal (all counties) Molina | The monthly ACE 78A and 78B reports now include “Supplemental Adjustments”, in addition capitation totals, to help provide more clarity and transparency for participating physician groups. |
1ECM – Enhanced Care Management; CS – Community Supports
2Medi-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 June 2024
| Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
| 6/12/24 | Closure (under Provider Oversight > Facility and Physician Additions) | Physicians | Medicare | Updated document with providers’ responsibilities for notifying members of contract terminations for primary care and behavioral health providers, per CMS requirements. |
| 5/30/24 |
| Physicians PPGs Hospitals | HMO, PPO | The Bariatric Surgery Performance Centers list has been updated. |
| 6/12/24 | Advanced and Cardiac Imaging (under Prior Authorization) | Physicians | Updated documents to reflect the name change for National Imaging Associates, Inc. (NIA) to Evolent Specialty Services, Inc. (Evolent). | |
| 6/14/24 | Coverage Explanation Healthy Pregnancy (under Benefits > Maternity) Genetic Testing (under Benefits) | Physicians PPGs Hospitals Ancillary providers | Updated relevant documents to add sex chromosome aneuploidy (X, XXY, XYY, XXX) screening to the California Prenatal Screening Program. | |
| 6/17/24 | Confirmation of Pregnancy (under Benefits > Maternity > Coverage Explanation) | Physicians PPGs Hospitals Ancillary providers | Medi-Cal | Added Health Net Confirmation of Pregnancy form. |
| 6/20/24 | Facility Site Review (under Quality Improvement) | Physicians PPGs | Medi-Cal | Reformatted Reference and Trainings Materials table and updated the following resources:
|
| 6/20/24 | Physician Certification Statement Form - Request for Transportation (under Forms and References) | Physicians | Medi-Cal | The form’s Certification paragraph has been updated. |
Behavioral Health Provider Operations Manual changes in June 2024
| Effective Date | Section | Topic | Summary |
| 6/12/24 | Section 3: Credentialing: Administrative Guidelines | Notification to Members of Contract Termination | Updated section with providers’ responsibilities for notifying members of contract terminations for primary care and behavioral health providers, per CMS requirements. |
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, including Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.