Archive for the 'Medi-Cal' Category

The U.S. Supreme Court has issued an opinion that upholds the Affordable Health Care Act

Thursday, Jun. 28th 2012 11:17 AM

The U.S. Supreme Court has issued an opinion that upholds the Affordable Health Care Act


This includes the individual mandate for coverage.  The case challenged the constitutionality of several parts of the law, including the rule that most people in the U.S. must get health coverage.   We will continue to carry out provisions of the law by thoughtfully implementing the new requirements for customers and members. We will also continue to look for ways to address increasing costs that are crippling our health care system, including: ·      Advancing our partnership with primary care physicians announced earlier this year that we believe will substantially improve quality and member health, and potentially reduce the trend in overall medical costs by as much as 20% by 2015. ·      Coordinating patient care through the use of IBM-Watson technology to promote evidence-based health care and ensure that millions of Americans receive the most effective courses of treatment.  We look forward to continuing our efforts to work with policymakers and other key stakeholders to build a health care delivery system that provides security and affordability to all Americans.

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Posted on Thursday, Jun. 28th 2012 11:17 AM | by Share of Cost | in Medi-Cal | 1 Comment »

Share of Cost, Brain Exercise Video Games Can Improve Kids’ School Performance

Friday, Dec. 23rd 2011 6:40 AM

Video puzzle games which exercise a child’s working memory were found to enhance abstract reasoning and problem solving skills significantly, researchers from the University of Michigan in Ann Arbor reported in Proceedings of the National Academy of Sciences. They added that the improvements persisted for at least three months after they stopped playing the games.

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Posted on Friday, Dec. 23rd 2011 6:40 AM | by Share of Cost | in Medi-Cal | No Comments »

Share of Cost, Brain Imaging Study Of Preschoolers With ADHD Detects Brain Differences Linked To Symptoms

Monday, Dec. 19th 2011 6:40 AM

In a study published today in the Clinical Neuropsychologist (e-publication ahead of print), researchers from the Kennedy Krieger Institute found differences in the brain development of preschool children with symptoms of Attention-deficit/Hyperactivity Disorder (ADHD).

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Posted on Monday, Dec. 19th 2011 6:40 AM | by Share of Cost | in Medi-Cal | No Comments »

Walgreens to Anthem script leave network January 1, 2012

Thursday, Nov. 3rd 2011 8:56 AM

In October, we wrote to you about contract talks between Express Scripts, the company that manages the drug store network for us, and Walgreens.  We’re writing today with an update so that you have the very latest news affecting your clients. Despite ongoing talks, it appears the two parties won’t reach an agreement before the end of the year. Absent a last minute agreement, Walgreens will leave the network on January 1, 2012.

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Posted on Thursday, Nov. 3rd 2011 8:56 AM | by Share of Cost | in Medi-Cal | No Comments »

Despite some enrollment losses, most California health plans still turned a profit in 2010

Wednesday, Nov. 2nd 2011 3:46 PM

Health insurance carriers ground California’s market-based health care system, serving about two-thirds of the state’s population. In addition to covering the privately insured, these companies also serve enrollees in managed care plans through Medi-Cal, Medicare, and other public programs.

While California health insurers are a strong economic force overall, enrollment was flat in health plans overseen by both the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). Most major California health plans saw revenue grow at a slower pace in 2010, while two reported declines in revenues, according to this year’s California Health Plans and Insurers from the California HealthCare Foundation (CHCF).

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Posted on Wednesday, Nov. 2nd 2011 3:46 PM | by Share of Cost | in Medi-Cal | No Comments »

Millions of Americans with a Pre-existing Condition Could Be Denied Coverage without Affordable Care Act Protections

Wednesday, Feb. 2nd 2011 6:16 AM

Millions of Americans with a Pre-existing Condition Could Be Denied Coverage without Affordable Care Act Protections: The U.S. Department of Health and Human Services has released a new report showing that, without the Affordable Care Act (ACA), up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, could of lose health insurance or be denied coverage altogether. The Pre-existing Condition Insurance Plan program serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a pre-existing condition. Check out “Voices of Health Reform: Cathy’s Story” on the White House Blog.

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Posted on Wednesday, Feb. 2nd 2011 6:16 AM | by Share of Cost | in Medi-Cal | No Comments »

Parents Of Students With Asthma And Allergies, How Do You Know When Your Child Is Ready To Self-Medicate At School?

Tuesday, Aug. 17th 2010 6:47 AM

Students with asthma and allergies will pack more than just a lunchbox and bookbag when they start school this year: They’ll be devising ways to keep their life-saving medications close at hand should they need them. No longer do they have to be locked up in the nurse’s cabinet or the office…

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Posted on Tuesday, Aug. 17th 2010 6:47 AM | by Share of Cost | in Medi-Cal | No Comments »

Dentist participation in Medicaid has been a persistent problem

Monday, Aug. 9th 2010 10:49 AM

Dentist participation in Medicaid has been a persistent problem, with fewer than one in four dentists nationwide seeing more than a handful of Medicaid patients in any given year. The most common reason dentists give for their low participation is inadequate reimbursement for the cost of treating Medicaid beneficiaries.

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Posted on Monday, Aug. 9th 2010 10:49 AM | by Share of Cost | in Medi-Cal | 1 Comment »

Medi-Cal Hotlines

Sunday, Aug. 8th 2010 6:11 AM
Medi-Cal Hotlines  
Border Providers (916) 636-1200
DHCS Medi-Cal Fraud Hotline 1-800-822-6222
Telephone Service Center (TSC) 1-800-541-5555
Provider Telecommunications Network (PTN) 1-800-786-4346

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Posted on Sunday, Aug. 8th 2010 6:11 AM | by Share of Cost | in Medi-Cal | No Comments »

Health Plan of San Mateo is expanding its covered services

Saturday, Aug. 7th 2010 6:09 AM

Providers cannot bill Medi-Cal or CHDP for Medi-Cal-covered mental health services (for pharmacies and labs only) and CHDP services rendered to children and adolescents enrolled in the Health Plan of San Mateo on or after July 1, 2010. As of July 1, the health plan will be responsible for reimbursing providers for such services. 

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Posted on Saturday, Aug. 7th 2010 6:09 AM | by Share of Cost | in Medi-Cal | No Comments »

The AEVS: Carrier Codes for Other Health Coverage list

Friday, Aug. 6th 2010 6:08 AM

The AEVS: Carrier Codes for Other Health Coverage list is updated monthly. A complete AEVS: Carrier Codes for Other Health Coverage list is available online. Additions and changes are shown in bold and underlined type. Providers may order a hard copy update of the section by calling the Telephone Service Center (TSC) at 1-800-541-5555. There were no updates for July 2010.

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Posted on Friday, Aug. 6th 2010 6:08 AM | by Share of Cost | in Medi-Cal | No Comments »

Suspension of Entities Submitting Claims for Suspended Providers

Thursday, Aug. 5th 2010 6:07 AM

The July Update is a list of providers who have been added to or removed from the Medi-Cal Suspended and Ineligible Provider List (S&I List) for the month of July. New providers have been added in bold and reinstated providers were removed from the following lists: susp A, susp C, susp E, susp G, susp J, susp P, susp R, susp S, susp T and susp U. Always refer to the S&I List when verifying provider ineligibility.

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Posted on Thursday, Aug. 5th 2010 6:07 AM | by Share of Cost | in Medi-Cal | 1 Comment »

Welfare and Institutions Code 14018.2 requires providers to make a good faith effort

Wednesday, Aug. 4th 2010 6:06 AM

Welfare and Institutions Code 14018.2 requires providers to make a good faith effort to verify the identity of a Medi-Cal recipient by matching the recipient’s name and signature on their Medi-Cal card with a valid California driver’s license, ID card issued by the Department of Motor Vehicles, another type of picture identification card or other credible document of identification.

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Posted on Wednesday, Aug. 4th 2010 6:06 AM | by Share of Cost | in Medi-Cal | No Comments »

Department of Health Care Services (DHCS) will only accept the National Provider Identifier

Tuesday, Aug. 3rd 2010 6:04 AM

Providers are reminded that t he Department of Health Care Services (DHCS) will only accept the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims. This policy has been in effect since October 1, 2008.

To ensure timely payment, pharmacies using the Medi-Cal POS NCPDP Pharmacy Transaction Specifications, Third Party Vendors (Dial-Up and Leased-Line) system must include the NPI of any practitioners prescribing drugs for Medi-Cal recipients. Claims submitted with incorrect or invalid NPIs may cause a delay in payments and lead to an audit of all claims submitted by the pharmacy.

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Posted on Tuesday, Aug. 3rd 2010 6:04 AM | by Share of Cost | in Medi-Cal | No Comments »

Medi-Cal Claims: A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission

Monday, Aug. 2nd 2010 6:03 AM

A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between hospitals and nursing homes during the transfer of the recipient. Providers see this on their Remittance Advice Details (RADs) as a claim denied by RAD code 010.

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Posted on Monday, Aug. 2nd 2010 6:03 AM | by Share of Cost | in Medi-Cal | No Comments »

California – Department of Health Care Services (DHCS) will direct the fiscal intermediary

Friday, Jul. 30th 2010 1:01 PM

Fiscal Year 2010-11 State Budget Reimbursement Contingency: Since the State of California did not enact the fiscal year 2010-11 budget by June 30, 2010, the Department of Health Care Services (DHCS) will direct the fiscal intermediary, HP Enterprise Services, to implement provisions pursuant to state law, to continue processing and adjudicating claims as outlined below.

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Posted on Friday, Jul. 30th 2010 1:01 PM | by Share of Cost | in Medi-Cal | No Comments »