Claims Issue for Contraceptive Rings and Patches
The Department of Health Care Services (DHCS) has identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program claims for HCPCS code J7303 (contraceptive vaginal ring) and J7304 (contraceptive transdermal patch) to erroneously deny with Remittance Advice Details (RAD) code 9942: NCCI (National Correct Coding Initiative) quantity billed is greater than the allowed MUE (Medically Unlikely Edit) quantity.
DHCS and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.
Health Access Programs (HAP) card activation
Effective immediately, providers are not to reissue HAP cards to another Family Planning, Access, Care and Treatment (Family PACT) applicant or client. The reactivation of HAP cards shall only be provided to the original client the card was issued to. Specific sections of the Family PACT Program’ Policies, Procedures, and Billing Instructions manual related to this update will be published in a future Family PACT Update.
Claims Erroneously Denied for Contraceptive Implant and Intrauterine Devices
The Department of Health Care Services (DHCS) has identified a claims processing issue causing Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs claims to be erroneously denied with Remittance Advice Details (RAD) codes 0082: Service exceeds maximum allowed by Medi-Cal policy and 0621: The monthly/yearly limit for this procedure has been exceeded. The claim is denied for the following HCPCS codes:
HCPCS Code Description
J7297 Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg
J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies
No action is required of providers. DHCS and the California Medicaid Management Information System Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.
Availability of long-acting reversible contraceptives in Los Angeles County clinics through a Medicaid state plan amendment program Full Article
Select Comprehensive Family Planning Services Policy Update
The Family Planning, Access, Care and Treatment (Family PACT) program will provide time-limited supplemental payments, to Family PACT providers
for Evaluation and Management (E&M) office visits rendered for comprehensive family planning services for the period of
July 1, 2019 through June 30, 2020. These supplemental payments are equal to 150 percent of the reimbursement amount for procedure codes 99201, 99202, 99203, 99204, 99211, 99212, 99213, and 99214.
Accuracy and Correction of Claims or Payments
Family PACT providers are responsible for all claims submitted regardless of who completes the claim on behalf of the provider. Family PACT providers are responsible for the review and verification of the accuracy of claims payment information promptly upon the receipt of any payment. The Family PACT provider agrees to seek correction of any claim errors through the appropriate processes as designated by the Department of Health Care Services or its fiscal intermediary (Source: Medi-Cal Provider Manual, Part I and your signed Form DHCS 6153, Medi-Cal Telecommunications Provider and Biller Application/Agreement).
ACA's Nondiscrimination Policy Applies to Family PACT
Section 1557 of Patient Protection and Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities. In effect since 2010, Section 1557 builds on long-standing federal civil rights laws: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.
Effective July 18, 2016, the Health and Human Services (HHS) Office for Civil Rights issued its final rule implementing Section 1557 at Title 45 Code of Federal Regulations (CFR) Part 92. The rule applies to any health program or activity, any part of which receives federal financial assistance, an entity established under Title I of the ACA that administers a health program or activity, and HHS. In addition to other requirements, Title 45 CFR Part 92.201, requires:
For more information about the application and requirements of the final rule implementing Section 1557, providers should contact their representative professional organizations. They may also visit the Section 1557 of the Patient Protection and Affordable Care Act page of the HHS website to find sample materials and other resources.
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