DHCS releases duals project toolkit October 6, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association. The toolkit contains several documents, including an overview and several fact sheets that include information on the following: How to submit crossover claims to Medi-Cal plans Contracting with Cal MediConnect plans How crossover claims are processed for Medi-Cal managed care patients Continuity of care Sample patient letters (for contracted and non-contracted physicians) The toolkit also confirms that if a patient opts out of Medicare Advantage and remains with fee-for-service Medicare, the Medi-Cal managed care plan cannot require authorizations for physician services as the secondary payor (see the Coordinated Care Initiative Overview fact sheet for more information). It should be noted that no change has been made to the rules governing the billing of the 20 percent Medicare copay for dual eligible patients. It continues to be unlawful to bill dual eligible patients. In limited circumstances, Medi-Cal may cover Medicare coinsurance and copays. Such "crossover" claims for Medicare coinsurance and copays should be sent to the patient's Medi-Cal plan (see Payment for Medicare Physician Services Under the CCI fact sheet for more information. Physicians should also be aware that the new Cal MediConnect "Choice Form" that is now online is only a visual sample, indicating patients must use their unique forms sent to them in their "Plan Choice" booklets. Lastly, if you or your patients have questions that the plan cannot respond to, you can always contact the Cal MediConnect Ombudsman at (855) 501-3077 (TTY 1-855-847-7914), Monday through Friday, 9 a.m. to 5 p.m. For more details on Cal MediConnect, visit www.calduals.org and www.cmanet.org/duals. Comments are closed.
