Correspondences

Please see the following PDF links below. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here

2019

Medicare Beneficiary Identifier (MBI)

The MACRA Act of 2015, mandates Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSN) from all Medicare cards to address the risk of Medicare beneficiary medical identity theft. CMS will mail out new Medicare Cards to Medicare Beneficiaries starting April 2018 through April 2019. 

By clicking on the CMS web links below, you will be leaving the IEHP website.

For more information regarding the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.html.

For an overview of the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/.

New Medicare card resources:

• New Medicare Card: Information for Partners & Stakeholders (PPT)
• You're getting a new Medicare card! (PDF)
• New Card! New Number! (PDF)
• "10 Things to Know About Your New Medicare Card" (PDF)
• Your New Medicare Card: Information for People with Medicare (PPT)

For additional resources regarding the new Medicare cards, please visit https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-Employers.html.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Newsletters

Don't miss out on the latest news! The Heartbeat, IEHP's Provider Newsletter; ScrubTalk, Provider Staff Newsletter; keep you in the know about our newest programs, incentive opportunities, study results, and more. 

Proposition 56 

Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, now includes proposed supplemental payments for physicians participating in Medi-Cal Fee-For-Service (FFS) and Medi-Cal Managed Care.

• Proposition 56 Notice (PDF)
• Proposition 56 Extension Notice SFY 18/19 (PDF)
• Proposition 56 FAQs (PDF)
• Proposition 56 FAQs SFY 18/19 (PDF)
• Prop56 - Paid Claims Dispute Request Form (PDF)
• Prop56 - Encounter Dispute Request Form (PDF)

Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Ground Emergency Medical Transport (GEMT) Payment

The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019.

• GEMT Dispute Request Form (PDF)

Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Public Health Advisory

• Severe Acute Pulmonary Disease Associated with Cannabis or Cannabidiol Oil (PDF) - August 15, 2019
• Nationwide Shortage of Tuberculin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice (PDF) - August 5, 2019

By clicking on the links below, you will be leaving the IEHP website.

Centers for Disease Control and Prevention (CDC)

The CDC has developed a one-stop-shop toolkit with products about vaccines and measles. These products include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. (By clicking the links below, you will be leaving the IEHP website.)

• Measles Outbreak Toolkit
• Toolkit for Healthcare Providers
• Measles FAQs

California Department of Public Health (CDPH)

The California Department of Public Health (CDPH) has developed two new measles tools for providers. Both tools are attached and can be found on the CDPH Measles Disease webpage. (By clicking on this link, you will be leaving the IEHP website.)

• Summary of Current Recommendations on Measles Immunization CDPH (PDF)
• Should I Test for Measles: A Guide for California Healthcare Providers (PDF)

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. (By clicking on this link, you will be leaving the IEHP website.)

Regulatory Updates 

Read APL 17-009 (PDF) and DPL 17-002 (PDF) for information regarding Provider-Preventable Conditions. Visit Reporting of Provider Preventable Conditions for DHCS instructions for online reporting. By clicking on these links, you will be leaving the IEHP website.

Medicare Outpatient Observation Notice (MOON)

In the event any Medicare recipient has been in a status of outpatient observation for greater than 24 hours, Acute Hospitals are required to provide Medicare Members with a Medicare Outpatient Observation Notice (MOON). Medicare recipients must receive the MOON within 36 hours of admission to observation level of care.

Please refer to the following website for further details on MOON requirements at https://www.federalregister.gov/articles/2016/08/22/2016-18476/medicare-program-hospital-inpatient-prospective-payment-system-for-acute-care-hospitals-etc.  By clicking on this link, you will be leaving the IEHP website.

Document Catalog:

1. MOON FAQs (PDF)
2. MOON Instruction Summary (PDF)
3. CMS Manual System 10611_Pub 100-04 Medicare Claims Processing MOON Instructions (PDF)
4. MOON Forms
   • MOON English (PDF)
   • MOON English Large Print (PDF)
   • MOON Spanish (PDF)
   • MOON Spanish Large Print (PDF)
5. MOON Correspondence (PDF)

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Cal MediConnect Quality Withhold Measures

• Cal MediConnect Quality Withhold Measures (PDF)
• California Specific Quality Withhold Technical Notes for DY 2 to 5 (PDF)
• Core Quality Withhold Technical Notes for DY 2 to 5 (PDF)

Flu Updates

The flu season is upon us and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) published the updated recommendations regarding the use of influenza vaccine. Vaccine manufacturers are expected to provide adequate vaccines this year.

To assist you, IEHP will continually update you on the latest recommendations, news and resources on these flu viruses. As the flu season progresses, you may see an increase in office visits from the Members with flu-like symptoms - and if they are unable to reach you after hours, refer them to our 24-hour Nurse Advice Line, 7 days a week, including holidays at (888) 244-IEHP (4347). 

• Careful Antibiotic Use  (PDF)
• Pediatric Clinical Practice Guideline Summary (PDF)
• Adult Clinical Practice Guideline Summary (PDF)

Web Resources

By clicking on these links, you will be leaving the IEHP website.

• http://eziz.org
• https://www.phcdocs.org/Programs/AWARE

Preventive Services

Immunizations

By clicking on these links, you will be leaving the IEHP website.

• CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
• CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
• CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html
• USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization
• California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do
• Immunization Timing 2018 (PDF)

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.