Providers Who Are Replacing Multiple Medi-Cal and Child Health and Disability Prevention

NPI Registration Deadline Extended to November 25, 2007

The deadline to register National Provider Identifiers (NPIs) with Medi-Cal has been extended to November 25, 2007. Providers who are already registered and need to update any information may only do so through October 20, 2007.

Providers who are replacing multiple Medi-Cal and Child Health and Disability Prevention (CHDP) provider numbers with one NPI are reminded that the
“pay-to” address, EFT account and PIN of the first Medi-Cal or CHDP number entered during the registration process will, by default, transfer to the new single NPI record.

Also, only one Remittance Advice Details (RAD) and one 835 transaction (for example, Claims Payment and Remittance Advice) will be returned to the provider with claim payment information for the multiple provider numbers registered under the single NPI. Furthermore, only one 1099 tax form will be issued for the single NPI record.

In cases where a provider wishes to receive more than one 835, paper RAD,
1099 tax forms or differing “pay-to” addresses, the California Department of Health Services (CDHS) encourages the use of NPI subparts. Providers subject to cost-reporting requirements should consider the difficulty of consolidating multiple Medi-Cal numbers under one NPI prior to registering. Providers wishing to make updates to previously registered NPIs may do so using the NPI Collection (NPIC) tool through October 20, 2007. Effective October 21, 2007, providers must submit all NPI registration updates by submitting a supplemental application form to the Provider Enrollment Branch (PEB).

For questions regarding NPI registration, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), option 16 from the main menu, then option 18 from the submenu.

Provider Number Dual-Use Period
Began May 23, 2007

Effective May 23, 2007, the California Department of Health Services (CDHS) instituted a dual-use provider number period. Providers must use their Medi-Cal provider number on all claim transactions, and may also include their National Provider Identifier (NPI) on some transactions. Also, providers may receive one NPI (in addition to their Medi-Cal provider number) on claim payment responses via the electronic ASC X12N 835 transaction and the Claims Financial Summary portion of the Remittance Advice Details (RAD).

Please see Dual-Use Period, page 3

Border Providers...... (916) 636-1200

CDHS Medi-Cal Fraud Hotline...... 1-800-822-6222

Telephone Service Center (TSC)...... 1-800-541-5555

Provider Telecommunications Network (PTN)...... 1-800-786-4346

EDS  PO Box 13029  Sacramento, CA  95813-4029

For a complete listing of specialty programs and hours of operation, please refer to the Medi-Cal Directory in the provider manual.

Opt Out is a service designed to save time and increase Medi-Cal accessibility. A monthly
e-mail containing direct Web links to current bulletins, manual page updates, training information, and more is now available. Simply “opt out” of receiving this same information on paper, through standard mail. To download the Opt Out enrollment form or for more information, go to the Medi-Cal Web site at , and click the “Learn how...” link under OPT OUT on the right side of the home page.

Medi-Cal Update – Program and EligibilityJune 2007

Dual-Use Period (continued)

Some claim forms, however, only have space available for one provider number. In that case, the Medi-Cal provider number must be used. These forms include:

All Direct Data Entry (DDE) applications: Internet Professional Claim Submission (IPCS),
Real-Time Internet Pharmacy (RTIP) and the Point of Service (POS) network
Electronic pharmacy claim form (NCPDP 5.1/1.1 standard)
All proprietary Medi-Cal forms:

Form Number / Form Name
18-1 / Request for Extension to Stay in Hospital
18-1C (Pin-Fed) / Request for Extension to Stay in Hospital
18-2 / FAX Request for Extension to Stay in Hospital
18-3 / Fax Treatment TAR for Mental Health Stay
20-1CZ / Long Term Care Treatment Authorization Request
25-1CZ / Payment Request for Long Term Care
30-1 / Pharmacy Claim Form
30-4 / Compound Drug Pharmacy Claim Form
50-1 / Treatment Authorization Request
50-1C / Treatment Authorization Request (Pin Fed)
50-2 / FAX Treatment Authorization Request
50-2C / FAX Treatment Authorization Request (Pin Fed)
50-3 / Treatment Authorization Request
55-1 / Medi-Cal Managed Care Authorization
60-1 / Claims Inquiry Form
60-1C / Claims Inquiry (Pin Fed)
90-1 / Appeal Form
PM 160 / CHDP Assessment Confidential Screening/Billing Report
PM 160 INFO / CHDP Assessment Confidential Screening/Billing Report
TAR 3 Form / Treatment Authorization Request Attachment Form

Please check the Medi-Cal Web site () for additional exceptions and technical details about dual-use submission.

Medicare Crossover Claims

Medi-Cal currently receives electronic crossover files from the Medicare Coordination of Benefits Contractor (COBC), Group Health Incorporated (GHI). These crossovers, commonly referred to as “automatic crossover claims,” are transmitted by the COBC and processed automatically by
Medi-Cal.

Providers using an NPI to bill Medicare need to register that NPI with Medi-Cal so the electronic crossover process can identify providers and claims can be processed for payment. Providers are urged to use both their Medi-Cal provider number and NPI on claims to start the transition and test their systems. During the dual-use period, NPIs will be returned to Medi-Cal providers on the
Medi-Cal Claims Financial Summary portion of the Remittance Advice.

Note:Paper and electronic Computer Media Claims (CMC) crossover claims received directly from providers will be rejected if they include only the NPI.

Please see Dual-Use Period, page 4

Medi-Cal Update – Program and EligibilityJune 2007

Dual-Use Period (continued)

Obtaining an NPI

Providers who have not yet obtained an NPI can submit an online application at the NPPES Web site () or by mail to:

NPI Enumerator

P.O. Box 6059

Fargo, ND 58108-6059

When applying for an NPI, providers must include their legacy identifiers for all payers (for example, health insurance plans, state Medicaid agencies, Medicare). If reporting a Medicaid number, include the associated state name. This information is critical for payers to develop crosswalks and transition to the NPI.

Register NPI with Medi-Cal

Because of this dual-use period, CDHS is extending the NPI registration deadline to
November 25, 2007. Providers who have not yet registered their NPI must do so through the online NPI Collection (NPIC) system. To register through NPIC, go to the Medi-Cal Web site, then click the “NPI” link, then the “Register/Update/Inquire NPIs” link. NPIC allows Medi-Cal and Child Health and Disability Prevention (CHDP) providers to register one NPI for each active Medi-Cal/CHDP provider number currently enrolled.

Additional Resources

For additional questions regarding NPI, please contact the Telephone Service Center (TSC) at
1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then select option 18 from the submenu.

Provider Action Required to Maintain Electronic Transaction Services

Providers who registered their National Provider Identifiers (NPIs) with Medi-Cal but did not authorize Medi-Cal to update select agreement forms will have access terminated to electronic services, including Medi-Cal Web site transactions and Point of Service (POS) eligibility verifications, on November 26, 2007.

Providers can update agreement forms through the NPI Collection (NPIC) tool through
October 20, 2007. The NPIC tool is accessed on the Medi-Cal Web site () by clicking “NPI” under “Provider Resources” and then “Register/Update/Inquire NPIs.” After reading the important NPI information, click the “Continue to Register/Update/Inquire NPIs” button. Updates can be made on the “Provider Agreement Update” page of the NPIC tool.

Providers who do not update their agreement forms prior to October 20, 2007 and are terminated from electronic access must complete new agreement forms designating the NPI as their identifier. The cost-free and simplified option of electronically updating existing agreements is not available after October 20, 2007.

Providers who prefer to update their information using the paper NPI Registration Form should call the Telephone Service Center (TSC) at 1-800-541-5555, and choose option 16 followed by option 18. To complete the form, providers should check the “Update to Previously Submitted Information” box, update the agreement forms listed in the “Agreement Update Information” section, complete all required information, make a copy for their records and return the form with a copy of the National Plan and Provider Enumeration System (NPPES) verification document to the address located at the bottom of the form.

The option to update agreement forms using the paper NPI Registration Form will only apply to those forms received prior to October 20, 2007. Any forms received after that date will not be processed and providers must complete new agreement forms designating the NPI as their identifier.

Please see Provider Action, page 5

Medi-Cal Update – Program and EligibilityJune 2007

Provider Action (continued)

The following forms expire on October 20, 2007 unless providers authorized Medi-Cal to automatically update them.

Biller: Medi-Cal Hardcopy Application Agreement
California Children’s Services (CCS) Program Individual Provider Application for Paneling Physicians and Podiatrists (DHS 4514)
California Children’s Services (CCS) Program Individual Provider Application for Paneling Allied Health Care Professionals (DHS 4515)
CHDP Telecommunications Provider and Biller Application/Agreement (DHS 4431)
EFT Enrollment Authorization
Electronic Health Care Claim Payment/Advice Receiver Agreement (ANSI ASC X12N 835 Transaction)
Medi-Cal Eligibility Verification Enrollment Form
Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHS 6153)
Medi-Cal Point of Service (POS) Network/Internet Agreement
OPT OUT Cancellation Form
Change of E-mail Address Form
OPT OUT Enrollment Form
Pay-To Address Change Notification (DHS 6129)
Point of Service (POS) Device Usage Agreement
Provider: Medi-Cal Hardcopy Biller Notification Form
Qualified Provider Application for Presumptive Eligibility Participation and Presumptive Eligibility Qualified Provider Responsibilities and Agreement (MC 311)

For more information on NPI registration, call TSC at 1-800-541-5555 and choose option 16 followed by option 18.

New Billing Requirements Prohibit SSNs: Implementation Update

Implementation of the new billing requirements that prohibit most providers from billing Medi-Cal using a recipient’s Social Security Number (SSN) has been delayed until late summer 2007. This delay will allow the California Department of Health Services (CDHS) to complete its outreach to recipients and providers.

All providers are encouraged to use the Medi-Cal identification number from the recipient’s Benefits Identification Card (BIC) or paper ID card when verifying eligibility, billing Medi-Cal or submitting Treatment Authorization Requests (TARs), instead of using the recipient’s SSN.

Please see SSN Update, page 6

Medi-Cal Update – Program and EligibilityJune 2007

SSN Update (continued)

The Medi-Cal ID number is located on the front of the BIC and consists of a 9-digit Client Index Number, a Check Digit and a 4-digit Issue Date. The issue date is used to deactivate cards that have been reported as lost or stolen.

Recipient Outreach

Providers can assist with the recipient outreach effort by:

Reminding recipients to take their BIC with them to the doctor, pharmacy, hospital or any other health care provider to receive services.
Instructing recipients to contact their county welfare office if they do not have a valid BIC or paper ID card, or if they need to report a lost or stolen BIC.
Printing a copy of the Always Take Your BIC With You notice and sharing it with
their Medi-Cal patients or the patients’ family members, caretakers or authorized representatives. The notice is available in multiple languages on the Medi-Cal Web site
(). From the home page, click the “SSNs Prohibited: Summer 2007 Implementation” link in the “What’s New” area.

Use of SSNs

CDHS recognizes the importance of protecting the identity and health information of recipients and strongly encourages all providers to avoid using a recipient’s SSN whenever possible.

Please see future Medi-Cal Updates for more information.

TAR Review and Appeal Process Update

An article that ran in last month’s Medi-Cal Update informed providers that Treatment Authorization Requests (TARs) are being reviewed without regard to timeliness of submission. In addition, the article announced that effective April 1, 2007, the TAR appeal system was consolidated into a
one-level appeal process.

Manual Updates

Manual updates related to these changes include the following:

Revision of the term “prior authorization” to “authorization”
Removal of many instructions related to retroactive TARs
Removal of all instructions related to clock-stopping initial TARs, including removal of the TAR Submission: Clock-Stop Fax Transmittal Form section.
Revised information for ordering the Manual of Criteria for Medi-Cal Authorization

The following manual replacement pages are updated to reflect the information announced last month: tar 1 thru 12 (Part 1), tar comp 1 thru 9 and 11 thru 13 (Part 2) and tar submit 1 (Part 2).

Medi-Cal Update – Program and EligibilityJune 2007

2007 – 2008 State Budget Reimbursement Contingency

If the state of California does not enact the fiscal year 2007 – 2008 budget by June 30, 2007, the California Department of Health Services (CDHS) will direct the Fiscal Intermediary, EDS, to implement provisions pursuant to state law to continue processing and adjudicating claims as outlined below.

EDS will process and adjudicate claims for the following programs, regardless of date of service.

Medi-Cal
Family PACT (Planning, Access, Care and Treatment)
California Children’s Services (CCS)/Medi-Cal
Child Health and Disability Prevention (CHDP)/Medi-Cal
Abortion

EDS will withhold all reimbursements for the following programs regardless of dates of service. The last warrant date for claims for these programs will be June 21, 2007.

CCS-only
Genetically Handicapped Persons Program (GHPP)
Healthy Families (HF)
CHDP-only (that is, claims for clients with aid code 8Y)

Effective for dates of service on or after July 1, 2007, claims submitted by provider types for which contingency funding is not available will continue to be processed, but reimbursement for these claims will be withheld until the state budget is approved and EDS receives approval from the state to resume reimbursement. (Claims will continue to pay for dates of service prior to
July 1, 2007.) The following programs will be affected by the temporary withhold:

Expanded Access to Primary Care Programs (EAPC)
Cancer Detection Programs: Every Woman Counts (CDP: EWC)
Children’s Treatment Program (CTP)

All providers are asked to continue to render services and submit claims for processing.

2007 – 2008 Checkwrite Schedule

Effective immediately, the checkwrite schedule is updated for fiscal year 2007  2008. This schedule reflects warrant release dates and Electronic Fund Transfer dates of deposit for the following programs:

Medi-Cal
County Medical Services Program (CMSP)
California Children’s Services (CCS)
Genetically Handicapped Persons Program (GHPP)
Abortion
Family PACT (Planning, Access, Care and Treatment)
Healthy Families (HF) Program
Child Health and Disability Prevention (CHDP)
Cancer Detection Programs: Every Woman Counts (CDP: EWC)
Expanded Access to Primary Care (EAPC)

This information is reflected on manual replacement page check 1 (Part 1).

Medi-Cal Update – Program and EligibilityJune 2007

Injectable Naltrexone New Medi-Cal Benefit

Effective for dates of service on or after July 1, 2007, HCPCS code J2315 (injection, naltrexone, depot form 1 mg [Vivitrol®]) is now reimbursable as a Medi-Cal benefit. The drug’s manufacturer, Cephalon, requires physicians who administer this drug must enroll with the company’s Vivitrol® support program (VIP³); their contact number is 1-800-848-4876.

The recommended dose is 380 mg delivered intramuscularly every four weeks or once per month. A Treatment Authorization Request (TAR) is required. An adequate initial trial of this drug is three months; authorization will not be granted beyond the maximum of six months. The provider must include the following documentation when requesting a TAR:

Recipient must have definitive diagnosis of alcoholism (ICD-9-CM diagnosis code
303.90 – 303.93)
Recipient must have ongoing psychosocial counseling
Recipient must have “negative” random urine screens demonstrating abstinence from alcohol and illicit drugs
Physician is experienced in treating addiction or certified by the American Society of Addiction Medicine, or a psychiatrist through the Drug/Medi-Cal program.

This information is reflected on manual replacement pages mcp cohs 7 (Part 1) and mcp gmc 7
(Part 1), mcp pre 6 (Part 1), mcp two plan 6 (Part 1), inject list 19 (Part 2) and supp drug op 4
(Part 2).

Automated Remittance Data Services (ARDS) Update

Effective immediately, Automated Remittance Data Services (ARDS) is available only through electronic download from a Bulletin Board System archive. Magnetic tape and diskette transmission of Remittance Advice Details (RAD) information via ARDS is discontinued except for existing users.