Provider Bulletin Vol. 23 No. 4 • April 2014 g 30 Years of Service Celebratin Administrative Offices 4050 Calle Real Santa Barbara, CA 93110 805.685.9525 1288 Morro St., Suite 100 San Luis Obispo, CA 93401 Toll Free 1.800.421.2560 CenCalHealth.org Central Phone Lines: Provider Services 805.562.1676 Claims Services 805.562.1083 Pharmacy Services 805.562.1080 Health Services 805.562.1082 Member Services 877.814.1861 IN THIS ISSUE • Changes to CCS Pharmacy Authorizations • Procedure Codes Requiring a HealthHelp Consult Updated • ICD-10 Update: Frequently Asked Questions (FAQs) Available Online • Instructions for Requesting Interpreter Services • HealthHelp RadConsult Webinars • Claims Corner o eCHDP Available! • Insert: Formulary UpdatesJanuary-March 2014 CHANGES TO CCS PHARMACY AUTHORIZATIONS Effective immediately, CenCal Health’s Pharmacy Benefits Manager (PBM), MedImpact, will process pharmacy authorizations for the Santa Barbara California Children’s Services (CCS) Program. For any medications that require prior authorization, submit a Medical Request Form (MRF) to MedImpact via fax at 805.685.7781 and your request will be processed using national and plan guidelines. If you have any questions regarding this transition, please contact MedImpact at 800.788.2949 or the CenCal Health Pharmacy Department at 805.562.1080. PROCEDURE CODES REQUIRING A HEALTHHELP CONSULT UPDATED CenCal Health has published on the website an updated list of codes that require a radconsult prior to rendering the service. The list is effective immediately and is available on CenCal Health’s website in the Authorization section as well as the Restricted section. Please refer to this list prior to submitting a radconsult. Radconsults can be submitted by contacting our Radiology Benefits Manager (RBM), HealthHelp via: • Phone 888.318.0276 • Fax: 888.717.9660 • Web: www.HealthHelp.com/CenCal Please contact Provider Services at 805.562.1676 with any questions. ICD-10 UPDATE: FREQUENTLY ASKED QUESTIONS (FAQS) AVAILABLE ONLINE In order to help offices prepare for the upcoming transition to ICD-10, CenCal Health published an FAQ to help answer some of the questions regarding the transition. Some of the questions addressed in the FAQs are: • What is ICD-10? • Who must comply with ICD-10? • Will there be a transitional period to submit ICD-9 and ICD-10? • Will the ICD-10 Conversion have an effect on provider reimbursement? These questions and more are answered in our FAQ at the link below: http://www.cencalhealth.org/for_providers/pdf/FAQ.pdf Please continue to check CenCal Health’s ICD-10 web page for more information on the transition and how offices can prepare. WWW.FACEBOOK.COM/PAGES/CENCAL-HEALTH INSTRUCTIONS FOR REQUESTING INTERPRETER SERVICES CenCal Health provides free interpreter services for its members who are Limited English Proficient (LEP) and have difficulty communicating with a healthcare provider because of language differences. It also provides American Sign Language Services for the Deaf and Hard of Hearing members for all their medical appointments. The use of any of CenCal Health’s Interpreter Services should only be used for eligible members of our programs. To access language services, please complete the steps below: • Identify the primary language of the LEP member. ○○ If the Primary Language is other than Spanish, please use CenCal Health’s current vendor for “Telephonic” interpretation. Certified Languages International provides interpreter services that are available 24/7 for 150 languages. ○○ If the Primary Language is Spanish, a “Face to Face” (on site) interpreter can be requested. ■■ For a “Face to Face” Interpretation, a provider, provider office staff or a member can request an interpreter by calling CenCal Health’s toll free Member Services line at 1.877.814.1861. ○○ The standard time frame for requesting a “Face to Face” interpreter is 48 hour notice or two business days. Requests made with less than two (2) day notice are dependent upon the availability of an interpreter and cannot be guaranteed. ○○ If a provider needs to cancel a scheduled interpreter appointment, please call the toll free Member Services line at 1.877.814.1861 and inform the Member Service Representatives of the reschedule or cancellation. Please do not call the interpreter directly to inform them of the cancellation. CenCal Health will communicate all cancellations and changes to the interpreter. Reminder: • The fundamental role of the interpreter is to facilitate communication between providers and patients who do not speak the same language nor share the same culture. The healthcare interpreter should not be expected to perform any duties other than interpret at the medical appointment. • If the member refuses an interpreter and chooses to use a family member or friend for interpreting, it must be noted in the member’s Medical Record. • If a provider needs to communicate by telephone with a LEP member (for e.g. lab results, change of dosage, etc.), please use Certified Languages International. HEALTHHELP RADCONSULT WEBINARS CenCal Health’s RBM, HealthHelp, offers weekly webinars on their online radconsult process. These webinars walk providers and staff through the steps to request a radconsult through HealthHelp’s website. HealthHelp’s webinars are prefect for training new staff or as a refresher. HealthHelp webinars are offered Tuesday, Wednesday, and Thursday from 8 AM PST to 1 PM PST and last 15 to 20 minutes. To RSVP for one of HealthHelp’s webinars, please contact HealthHelp’s Program Support Department at 800.546.7092 or email at RCSupport@healthhelp.com. If you have any questions, please contact Provider Services at 805.562.1676. C L A I M S eCHDP AVAILABLE! O Did you know State Medi-Cal accepts eCHDP R claims? eCHDP is a vendor who can assist providers in submitting claims electronically to N State Medi-Cal and other providers. With the E assistance of eCHDP, providers can now complete R PM160s electronically in the office. With over 60 fields to complete for every member visit, eCHDP will help offices complete the cumbersome forms accurately and quickly with fewer missed fields. CenCal Health is currently working with eCHDP to receive those claims which are outside of CHDP periodicity and the responsibility of CenCal Health. CenCal Health’s hope in the coming months is to form a partnership with eCHDP. Please visit eCHDP’s website for more information at http://www.echdp.com/index.html If you have any additional questions please contact CenCal Health at 805.562.1676. The Provider Bulletin is produced as a timely supplemental information service for provider office staff and is published monthly by the Provider Services Department. Questions and/or suggestions for articles may be made to psrgroup@cencalhealth.org or by calling 805.562.1676. Sign up for the electronic Provider Bulletin at http://www.cencalhealth.org/for_ providers/bulletins/index.html 2 Pharmacy Updates January - March 2014 CenCal Health has made several changes to our Formulary based on clinical review, provider interest, cost and utilization analysis. All of the changes represent development and growth of our current Formulary thus giving more choices to the prescribing physician. The changes are represented in summary on the chart below. Drug Class Restrictions / Limits Implementation Date Oral Inhaled Corticosteroid, OR Atrovent, Spiriva, Combivent, Ipratropium Solution, Serevent, Dulera, Advair Diskus 1/1/2014 Formulary Status Additions Breo Ellipta Dialyvite 800 Ultra D Asthma Vitamin / Mineral Deficiency Norco 5mg/325mg Pain Management Vicodin 7.5mg/325mg Pain Management Famvir Infectious Disease Tecfidera® Neurological DiseaseMiscellaneous Formulary: Step Therapy Formulary: Quantity restriction 60 tablets or less per month Quantity Restriction Formulary: Quantity and Day Supply Formulary: Quantity & Day Supply Formulary: Code 1 Restriction: No more than # 120 tabs per 30 days 1/1/2014 Restriction: No more than # 120 tabs per 30 days 1/1/2014 Code 1: HSV II, Shingles, or HSV I in HIV patient 1/1/2014 Formulary: PA Required Specialty Pharmacy DermatologyMiscellaneous Formulary Invokana® Diabetes Formulary: Quantity Limit Aubagio® Neurological DiseaseMiscellaneous Lidocaine Cream & Ointment 1/1/2014 1/1/2014 Restriction: 1 fill per month 1/1/2014 Restriction: No more than # 30 tabs per month 1/1/2014 Formulary: PA Required Specialty Pharmacy 2/1/2014 Changes Bromday Eye-General Disorders Non-Formulary Removed from Formulary 1/1/2014 Gilenya Neurological DiseaseMiscellaneous Non-Formulary Removed from Formulary 1/1/2014 DermatologyAnti-infective Formulary Removed Quantity Limit 1/1/2014 Lamisil 250 mg Tabs