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    • November 27, 2017

    Effective for dates of service on or after October 1, 2017, the following CPT codes are no longer reimbursable by the Every Woman Counts (EWC) program: 77055-77057. Effective for dates of service on or after October 1, 2017, the following CPT codes are reimbursable by the EWC program: 77065-77067. The Medi-Cal claims processing system is being... more

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    • November 27, 2017

    Effective for dates of service on or after December 1, 2017, an approved Treatment Authorization Request (TAR) will no longer override the once-in-a-lifetime limitations of pathology CPT codes 81435 Hereditary colon cancer disorders; genomic sequence analysis panel, must include sequencing of at least 10 genes, including APC, BMPR1A, CDH1, MLH1,... more

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    • November 27, 2017

    Effective for dates of service on or after December 1, 2017, Treatment Authorization Request (TAR) criteria have been updated for CPT codes 81211 (BRCA1, BRCA2 gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1), 81213 (...uncommon duplication/deletion variants) and 81162 (...full sequence analysis and full... more

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    • November 27, 2017

    The Department of Health Care Services (DHCS) identified a claims processing issue affecting Medicare/Medi-Cal crossover claims for outpatient services. This issue caused some crossover claims to under pay. The issue affected claims for dates of service from January 1, 2016, through September 30, 2016. No action is required on your part. Conduent... more

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    • November 27, 2017

    The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with split-billable procedure codes. This issue caused some claims to erroneously deny with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier is not present. The issue affected claims for dates of service... more

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    • November 27, 2017

    The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain outpatient and medical claims billed with National Correct Coding Initiative (NCCI) associated modifiers. This issue caused claims to erroneously pay. The issue affected claims for dates of service from August 1, 2015, through September 8, 2017. No... more

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    • November 27, 2017

    The Department of Health Care Services (DHCS) is working to resolve issues relating to Automated Eligibility Verification System (AEVS) messages that providers are receiving when verifying Medi-Cal eligibility for inmates. The following two messages are being received: Message 1: SUBRCRIBER MEDI-CAL COVERAGE HAS BEEN SUSPENDED, CONTACT COUNTY... more

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    • November 27, 2017

    In response to the fires across nine California counties, the Health and Human Services (HHS) Acting Secretary declared a public health emergency in California on October 15, 2017, and authorized a Section 1135 waiver, retroactive to October 10, 2017. For more information on the requirements and procedures for emergency enrollment, providers may... more

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