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