Message to Our Providers
Thank you to all of our providers and their staff who are working diligently to keep our members and community healthy during this unprecedented time.
Is CenCal Health open for business?
Yes. We are taking a variety of measures to ensure continuation of service for members and providers, while protecting staff. These actions come in response to a rapidly changing business environment due to the coronavirus, ongoing guidance from county and state officials, and school closings. As a public health measure, CenCal Health has implemented social distancing through staggered worktimes, teleworking for most employees, and closing our offices to visitors.
What is the expected impact of these changes?
Staffing levels may vary, so phone response times may lengthen. Please be patient. We are committed to answering or returning every call. Remember that you can find the answers to many questions inside the Provider Portal on our website.
What CenCal Health operations are temporarily changing?
- All in-person contact with the public, including community agencies, providers, hospitals, and other facilities, is suspended until further notice. This includes provider office visits, meetings, trainings, and outreach activities in public or other community settings. (Online training still available by request).
- Conference calls will replace in-person meeting attendance.
- All medical record reviews held at provider offices for HEDIS purposes are suspended until further notice. Reviews will be conducted remotely when access is available. Otherwise, providers may submit medical record images by secure email or fax.
- We have enacted our Pharmacy Emergency Preparedness Protocol. This allows a pharmacy in CenCal Health’s network to use an override code and provide an emergency fill/refill of a medication without having to contact the health plan or PBM. Refills can be up to 90 days for routine (non-narcotic) maintenance medications.
CenCal Health has reached out to our DME providers to ensure they are still providing necessary DME for our members. We have also reached out to our CBAS provider and ensured they are going to be checking on our aged members telephonically, delivering meals, and helping them stay in their homes.
How can we help patients get their prescriptions easier?
A list of network pharmacies providing free delivery of medications, as well as a mail-order option, is available on our website at cencalhealth.org/coronavirus
Effective March 25, 2020, CenCal Health elected to allow for prescription fills up to 90-days for routine (non-narcotic) maintenance medications in an effort to reduce both pharmacy deliveries and member trips to the pharmacy.
Has the process for authorizations changed?
No. Physicians and other providers are to continue to submit all services that require authorization in the same manner as they do today: Via the portal, secure link, or fax.
How should providers bill CenCal Health for COVID-19 testing?
DHCS provided the following guidance to all health plans on March 13, 2020:
HCPCS Code Addition for COVID-19:
- U0001, Laboratory testing of patients for SARS-CoV-2
- Has been deployed to the production environment on March 21, 2020
- Will be effective for dates of service beginning February 4, 2020
- U0002, Laboratory testing of patients for COVID-19
- Has been deployed to the production environment
- Will be effective for dates of service beginning February 4, 2020
The reimbursement rates for the above codes will be $35.91and $51.31 respectively. The rates are subject to Medi-Cal policy and contracted provider agreements, if applicable.
Can providers bill CenCal Health for telehealth services?
CenCal Health will reimburse for care delivered via telehealth per DHCS guidelines. Please see DHCS telehealth billing FAQ
- Capitated providers: Telehealth services will be included in capitation payment.
- FFS providers: Telehealth services will be paid at the contracted rate.
- BH providers: Telehealth services for mental health is allowable. Please contact The Holman Group for more information. If you are a FQHC and offer mental health services, please submit your claims with the Medi-Cal allowable codes. Visit DHCS’ website and search “COVID-19 Medi-Cal Services and Telehealth Notice.” Click here for more information.
Virtual Communication (audio and video)
Providers should continue to attempt to provide telehealth services via HIPAA-compliant telecommunications methods. However, according to the Department of Health and Human Services (HHS) issued on March 23, 2020, “…covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.”
We ask that you notify our Provider Services department by email at firstname.lastname@example.org if you intend to provide services over an electronic platform.
Telephonic Communication (audio alone)
This includes a brief communication with another practitioner or with a patient, who in the case of COVID-19, cannot or should not be physically present (face-to-face). Medi-Cal providers may be reimbursed using the below Healthcare Common Procedure Coding System (HCPCS) codes G2010 and G2012 for brief virtual communications.
HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 hours, not originating from a related evaluation and management (E/M) service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
HCPCS code G2012: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. G2012 can be billed when the virtual communication occurred via a telephone call.
Additionally, CenCal Health will waive the authorization requirement for ages 21 and over for CPT codes 98966-98968 to support providers in delivering care by telephone without video through June 30, 2020.
What is CenCal Health communicating to members?
We are including a bilingual COVID-19 FAQ sheet in our Spring 2020 Member Newsletter that mails in April, as well as posting it to our website. In addition to discussing precautions and symptoms, we discuss:
- Member Services phone lines are still open, but hold and wait times will be longer than usual.
- Pharmacy renewal limits, for an extra 30 days of most medications, have been removed.
- Their PCP may test for other illnesses first, such as the flu or strep, before COVID-19.
- There will be no cost to members if they need a coronavirus test, and CenCal Health will cover the costs of all medically-necessary treatment from the infection
Regarding testing for COVID-19, we instruct members to call their PCP if they have the symptoms described, and that their PCP will decide if they need testing and where to get it, if needed. We also tell them that their PCP may decide to test for other illnesses, like the flu or strep.
Most importantly, we are encouraging our members to call their PCP office first for next-step instructions if they have COVID-19 symptoms. We are cautioning members not to show up at an urgent care, ED or their PCP office with symptoms without calling first, in order to prevent possibly spreading the virus.
The County of Santa Barbara Public Health Department has created a Testing Triage Tool for providers to determine if patients are eligible for COVID-19 testing. Download the tool from the list of Alerts.
Where can I get current information on COVID-19 news?
Check credible sources for information, especially public health agencies.