Today, The Department of Veterans Affairs is scheduled to announce it will ease requirements for service members to qualify for post traumatic stress disorder benefits. The change was announced Saturday by President Barack Obama in his weekly address…

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Many doctors suggest that whole cow’s milk be avoided in the early months of an infant’s feeding. Lactation specialists go even further, counseling “mother’s milk only” until baby starts eating solid food. But new research from Tel Aviv University says that mothers who feed their babies cow’s milk in the first 15 days of life may be protecting their children from dangerous allergies later on…

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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.

Beginning in the late 1990s, several states greatly increased Medicaid rates for dentists, while also overhauling administrative processes and working to forge stronger ties with dental practitioners and other stakeholders in the field. This issue brief examines the results of those reforms and whether the efforts at better administration and outreach mattered as much as the rate increases in improving access to Medicaid dental care. Those findings are also compared with information on provider rates and participation in California.

The research indicates that while increases in provider payments were necessary to the success of the states’ reform efforts, they were not sufficient to produce substantial gains in either dentist participation or patients’ access to care. The authors conclude that in addition to raising reimbursement rates, Medicaid agencies must also revamp their administrative procedures and build partnerships with dental societies.

Read more: http://www.chcf.org/publications/2008/03/increasing-access-to-dental-care-in-medicaid-does-raising-provider-rates-work#ixzz0w8Fj2lQ7

For millions of children with allergies and asthma, heading back-to-school with high levels of fall pollens and molds in the air and exposure to potential allergens and viruses in class can really take a toll…

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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. 

Effective for dates of service on or after July 1, 2010, Health Plan of San Mateo is expanding its covered services by including the following:

• Medi-Cal-covered mental health services for pharmacies and labs only
• Child Health and Disability Prevention (CHDP) program

Members will not be affected by this change. Only provider billing will change.

Providers who have questions regarding the new services should call the Health Plan of San Mateo Provider Services Department at (650) 616-2106.

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.

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.

Eligibility or ineligibility must also be verified through the Health and Human Services (HHS) Office of Inspector General (OIG) List of Excluded Individuals/Entities.

Suspension of Entities Submitting Claims for Suspended Providers

Entities submitting claims for services rendered by a health care provider suspended from Medi-Cal or excluded from Medicare or Medicaid by the Federal Office of Inspector General are subject to Medi-Cal suspension.

Welfare and Institutions Code (W&I Code), Section 14043.61(a), states, in relevant part, that “a provider shall be subject to suspension if claims for payment are submitted under any provider number used by the provider to obtain reimbursement from Medi-Cal for the services, goods, supplies or merchandise provided, directly or indirectly, to a Medi-Cal recipient by an individual or entity that is suspended, excluded, or otherwise ineligible because of a sanction to receive, directly or indirectly, reimbursement from Medi-Cal and the individual or entity is listed on either the Medi-Cal Suspended and Ineligible Provider List or any list published by the Federal Office of Inspector General regarding the suspension or exclusion of individuals or entities from the Federal Medicare and Medicaid programs, to identify suspended, excluded, or otherwise ineligible providers.”

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.

Exceptions: The identification requirement is waived for persons 17 years of age and younger, persons in long term care and individuals receiving emergency care.

This information is reflected in the following provider manual:

Drugs commonly taken for a variety of common medical conditions including insomnia, allergies, or incontinence negatively affect the brain causing long term cognitive impairment in older African-Americans, according to a study appearing in the July 13, 2010 print issue of Neurology, the medical journal of the American Academy of Neurology…

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.

For additional questions regarding NPI or its use in claims billing, providers can review the NPI Overview page, or call the Telephone Service Center (TSC) at 1-800-541-5555.

Accelerated research findings leading to potentially significant new treatments for fragile X syndrome (FXS) will be presented to nearly 1,000 family members and professionals at the 12th International Fragile X Conference in Dearborn July 21-25…

I was searching the benefit and services for the Careington dental discount plans in California and found they have some good options for the dental plan 507. I am not sure how well the plan would work for the Share of Cost Medi-Cal program since the SOC program generally requires dental insurance but the discount plan should work for many others.  CareingtonDental.com web site indicates all of the dental service charges are reduced if performed by a participating general dentist.

That would mean you need to select a plan network dentist but I do not see this as a bad thing since a great majority of people without a dental plan do not go to the dentist anyway so what does it matter which dentist you eventually go too? It doesn’t!

A good item was the 20% discount for charges not listed which could be a lot depending on the office you visit. I found some important disclosures and copied them here for your review –  Implants and some whitening procedures will not be discounted by all participating carrington providers.

Implants and some whitening procedures will only be discounted if the participating careington provider has agreed to discount these procedures as part of their contract. These services will be offered, when applicable, at a 15% discount off of the provider’s normal fee. If the General Dentist’s normal fee for any procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that procedure

The disclosures as noted indicate this is a discount program and not an insurance plan as noted above. However it could possibly be used as a supplemental dental plan if the dentist goes along with it… Careington cannot guarantee specialty care in all areas. In cases in which you are referred to a participating specialist, you will generally receive 15% to 20% off their usual and customary fees. Please verify such benefits with each individual provider. Work in progress, after joining the plan, must be completed by the provider who started the work. Any procedures performed by a non-participating provider are not included. They cannot guarantee the continued participation of any provider. If he or she leaves the plan, you will need to select another provider. Not all types of providers may be available in your area.

Some providers may charge for missed or broken appointments if no prior notice is given. It is the member’s responsibility to verify that the provider is a participating provider. This plan does not include all procedures which might be provided. Any procedure delivered which is not listed on the Schedule of Services may cause additional cost to be incurred by the member. The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment because the treatment may require more than one procedure. Note to Utah Residents: This contract is not protected by the Utah Life and Health Guaranty Association. The program and the program administrators have no liability for providing or guaranteeing service and have no liability for the quality of service rendered.

I hope this brief review will help you make an informed dental plan decision. I would recommend purchasing it if you can locate a dentist near you in their network.

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.

Should the denied provider choose to dispute the claim and there is no resolution between the two providers regarding the dates in question, Medi-Cal could recoup the full reimbursement of the original erroneously paid claim, and will not make an adjustment without a correction request from that provider.

Incorrectly paid and denied claims can also create incorrect provider reimbursement data and inaccuracies in the health service records that may impact beneficiary share of cost, access to services and estate recovery.

For assistance in resolving these issues, providers are advised to write to the Correspondence Specialist Unit at:

Correspondence Specialist Unit
P.O. Box 13029
Sacramento, CA  95813-4029

For information about proper claim form completion, refer to the claim completion section in the appropriate Part 2 manual.

A York University study has shown for the first time how the drug misoprostol, which has been linked to neurodevelopmental defects associated with autism, interferes with neuronal cell function. It is an important finding because misoprostol is similar in structure to naturally-occurring prostaglandins, which are the key signaling molecules produced by fatty acids in the brain…

House Majority Leader Steny H. Hoyer (D-Md.) delivered a speech today on Democrats’ record on job creation and economic recovery, and how Republicans would take us back to the same failed Bush policies that led to the recession in the first place. Below are his remarks as prepared for delivery:

America has faced its share of trying times — times when not just our economy, but our nation, seemed in decline. But each time, with ingenuity, hard work and our distinctly American optimism, we have built our way out, and we’ve emerged stronger.

The American people are hurting. As a result of the greed, recklessness and illegal behavior on Wall Street, millions of Americans have lost their jobs, homes, life savings and their ability to get a higher education. Today, some 22 percent of our children live in poverty, and millions more have become dependent on food stamps for their food.