California Medicaid & Health Plans For Providers | California Health

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Join Our Network Thank you for your interest in becoming a California Health & Wellness network provider. We look forward to working with you to improve the health of the community.

If you are a contracted California Health & Wellness provider, you can register now. If you are a noncontracted provider, you will be able to register after you submit your first claim.

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You deserve the absolute best healthcare solution. That’s what California Health & Wellness gives you — a new option for high quality health coverage. California Health & Wellness takes care of you in more ways than one. If your claim is denied, you have the right to dispute the denial. Complete the Provider Dispute Form and send it to California Health & Wellness at: California Health & Wellness Attn: Claim Dispute P.O. Box 4080 Farmington, MO 63640-3835 You must send us your dispute within 365 days. California Health & Wellness will acknowledge receipt of your dispute within two working days of receipt of an electronic provider dispute, or within 15 working days of receipt of a paper provider dispute. California Health & Wellness will send you a written resolution of your dispute within 45 working days. (28 CCR 1300.71 and 28 CCR 1300.71.38).

MEDI-CAL At California Health & Wellness, we recognize the important role healthcare providers play in ensuring member access to high quality services. We are committed to developing lasting partnerships with hospitals, physicians and other healthcare providers by providing resources and support for you, when and how you need it. We also understand provider challenges with administrative tasks, and we’re dedicated to solutions that provide healthcare without the hassles. We want you and your staff to focus on what you do best — help our members get well, stay well and be well. (/members/medicaid.html)

Provider News MAY DELAYED IMPLEMENTATION OF PAYMENT INTEGRITY POLICIES 05/15/18

On March 14, 2018, California Health & Wellness (CHWP) advised providers via a provider update titled Five New Policies Implemented, of CHWP?s planned implementation of four new claims payment integrity policies. Such policies were to be effective as of May 16, 2018. The effective date of policy CC.PP.054, Physician?s Consultation Services, remains May 16, 2018, as previously communicated. (/newsroom/payment-integrity.html)

DHCS MEDI-CAL DOCUMENTING AND REPORTING IMMUNIZATION REQUIREMENTS 05/10/18

The Department of Health Care Services (DHCS) notified California Health & Wellness Plan (CHWP) on January 31, 2018, in All Plan Letter (APL) 18-004, that DHCS requires participating providers to document each member?s need for Advisory Committee on Immunization Practices (ACIP)-recommended immunizations as part of all regular health visits and to report the administration of immunizations within 14 days. (/newsroom/reporting-and-documenting-immunizations.html)

RENEWAL AGREEMENT: DIGNITY HEALTH HOSPITAL CONTRACTS 05/04/18

Dignity Health had issued a notice of contract termination with intent to renegotiate their system-wide provider agreements. Dignity Health, on behalf of its contracted/affiliated hospitals, has rescinded the termination and will continue to remain a part of the CHWP provider network. (/newsroom/dignity-hospital-contract-renewed.html)

APRIL PCP MEDICAL HOME PROGRAM ROLLS OUT 04/20/18

CHWP is instituting a Primary Care Medical Home model for all members. This model requires that members receive their primary care services from a primary care physician (PCP) chosen by and assigned to the member. (/newsroom/pcp-medical-home-program-rolls-out.html)

UPCOMING PROVIDER WEBINAR: DECREASING NTSV CESAREAN SECTION RATES - PUTTING IT INTO PRACTICE 04/06/18

California Health & Wellness, Health Net of California, Inc., and CalViva Health are presenting a webinar to assist participating hospitals in reducing the nulliparous, term, singleton, vertex (NTSV) cesarean section rates. (/newsroom/maternity-webinar---decreasing-ntsv-cesarean-section-rates.html)

BEHAVIOR ANALYST CERTIFICATION BOARD REQUIREMENTS AND STANDARDS 04/05/18

Effective January 1, 2018, California Health & Wellness (CHWP) and participating direct network physicians must meet and comply with the Behavior Analyst Certification Board (BACB) requirements and standards described in California Health and Safety Code section 1374.73 and California Insurance Code section 10144.51 as amended by the passage of Assembly Bill (AB) 1074. These rules of participation apply to behavioral health treatment and services related to pervasive developmental disorder, autism and applied behavioral analysis (ABA). (/newsroom/behavior-analyst-certification-board-requirements-and-standards.html)

MARCH FLU-STREP POLICY CHANGE 03/27/18

We have recently reviewed our Clinical Policy ?Influenza and Streptococcus Group A Testing,? and have decided to discontinue this policy. Effective January 30, 2018, we are no longer implementing the edit denying payment for influenza testing performed on the same date of service as streptococcus testing. This decision was based on an ongoing analysis of the clinical basis for the policy, and more importantly, based on compelling clinical feedback from network providers. (/newsroom/flu-strep-policy-change.html)

FIVE NEW POLICIES IMPLEMENTED 03/14/18

California Health & Wellness (CHWP) is implementing five new policies, effective May 16, 2018. Four of the policies outline acceptable billing practices and reimbursement methodologies for certain procedures and services. The fifth policy defines the medically necessary procedures for the diagnosis and treatment of Attention Deficit Hyperactivity disorder (ADHD). (/newsroom/five-new-policies-implemented.html)

REIMBURSEMENT FOR AMERICAN INDIAN HEALTH SERVICE PROGRAMS 03/08/18

Effective January 1, 2018, California Health & Wellness (CHWP) is required to reimburse American Indian Health Service Program providers for eligible services provided on or after January 1, 2018, at the applicable OMB encounter rate. (/newsroom/ihs-programs.html)

FEBRUARY BE PREPARED: UPCOMING DHCS PROVIDER CALLS ON APPOINTMENT AVAILABILITY 02/12/18

The California Department of Health Care Services (DHCS) has contracted with Health Services Advisory Group, Inc. (HSAG) to conduct a focused study to assess the extent to which Medi-Cal managed care health plans (MCPs), including California Health & Wellness Plan (CHWP), are meeting the appointment wait time standards. (/newsroom/be-prepared---upcoming-dhcs-provider-calls-on-appointment-availa.html)

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