24-678 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 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 (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 | Medi-Cal counties | Summary |
6/18/24 24-554m, HIP Incentive Program Offered Through December 31, 2024 | News & Announcements | Physicians
| Fresno Kings Madera | 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 24-612m, Let Pregnant and Postpartum Medi-Cal Members Know About the Benefits of Doula Services | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | 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 member about Mahmee maternal support services and how to register. |
6/20/24 24-638m, Medical Policies – May 2024 | Contractual | Physicians PPGs Behavioral Health providers
| Fresno Kings Madera | 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. |
1ECM – Enhanced Care Management; CS – Community Supports
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in June 2024
| Effective Date | Document name, URL and path (if applicable) | Audience | Summary |
6/12/24 |
(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 |
(under Benefits > Maternity) | Physicians PPGs Hospitals Ancillary providers | Updated document to add sex chromosome aneuploidy (X, XXY, XYY, XXX) screening to the California Prenatal Screening Program. |
6/17/24 |
(under Benefits > Maternity > Coverage Explanation) | Physicians PPGs Hospitals Ancillary providers | Added CalViva Health Confirmation of Pregnancy form. |
6/20/24 |
(under Quality Improvement) | Physicians PPGs
| Reformatted Reference and Training Materials table and updated the following resources:
|
6/20/24 | Physician Certification Statement Form - (under Forms and References) | Physicians
| 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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.