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​Medicare Advantage Plans

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Certification Process (Optional Enhancement)

Objective:  Provide a flowchart on the county Mental Health Plans (MHPs) submission of claims for Medi-Cal reimbursement for Short-Doyle/Medi-Cal (SDMC) reimbursable specialty mental health services provided to beneficiaries eligible for both Medicare and Medi-Cal (dual eligibles) whose Medicare coverage is provided through a Medicare Advantage plan (also known as a Medicare Risk HMO or Medicare Part C plan).
References:  INFORMATION NOTICES 09-09, 10-11, 10-23, 11-06, and 13-24
Process Steps: 
1.     If dual eligibles with FFS Medicare, MHPs are not required to bill Fee-For-Service Medicare for reimbursement for services which DHCS has determined are not covered by Medicare because the service, the provider type, or the combination of the service, provider type, and place of service are not reimbursable by Medicare.
2.     All Mental Health Plans periodically access MedCCC website to verify if insurance carrier on the list.
3.      Mental Health Plan obtains the certification letter certifying that the plan provides no additional coverage for specialty mental health services beyond that which is provided by FFS Medicare.  The certification letter must include the following information:
a.     The Medicare Advantage plan name;
b.     Federal contract number; and
c.     Calendar year(s) of service to which it applies, which must not include any year of service later than the year following the date of the letter.
4.     The MHP sends certification letter to MedCCC at Mental Health Services Division, County Customer Service Section at: MedCCC@DHCS.CA.GOV using the subject line: “FFS-Equivalent Coverage Certification.”
5.     MedCCC ensures the SDMC system will treat the plan as a FFS-equivalent plan when adjudicating services for the service dates covered by the certification letter.
6.     MHPs with claims which were previously denied because the services were not first billed to the beneficiary’s Medicare Advantage plan may submit replacement claims for any such denied claims which include services which no longer require billing to the Medicare Advantage plan before billing Medi-Cal.

 

Certification Status

Health Plan Name
Federal Contract #
Date Received
Implementation Date
Certified Date Range
(Revised Apr 10, 2017)
 
Aetna Health of California
H0523 & H5521
07/29/14
09/03/14
01/01/12 - 12/31/15

​Aids Healthcare Foundation,

dba Positive Healthcare Partners (PHP)

​H5852 ​01/13/17 ​01/25/17 ​01/01/14 - 12/31/17
Alameda Alliance for Health
H7292
02/25/14
04/24/14
01/01/10 - 12/31/15

​Alignment Health Plan formerly Citizens Choice

Healthplan HMO

​H3815
 
​01/24/17 ​01/26/17 ​01/01/13 - 12/31/17
​Blue Shield
​H0504
04/06/17
04/10/17
​01/01/14 - 12/31/17
Blue Shield of California ​H5609 ​04/06/17 04/10/17​ ​01/01/16 - 12/31/17
​CalOptima
​H5433
​11/16/16
​11/18/16
​01/01/14 - 12/31/17
Care First Total Dual Plan
H5928
01/13/17
01/25/17
01/01/08 - 12/31/17
​CareMore Health Plan ​H0544 ​05/09/16 ​06/15/16 ​01/01/16 - 12/31/16
Central Health Medicare Plan of California
H5649
07/13/16
08/24/16
01/01/12 - 12/31/17
Community Health Group
H5172
02/10/14
04/24/14
01/01/14 - 12/31/15
​Community Health Group
​H7086
​10/14/14
​01/13/15
​01/01/14 - 12/31/15
​Easy Choice Health Plan
​H5087
​10/07/14
01/13/15
​01/01/14 - 12/31/15
​Health Net of California, Inc.
​H0562
​01/03/17
​01/19/17
​01/01/14 - 12/31/17
​Health Plan of San Mateo
​H5428
​03/06/17
​03/07/17
0​1/01/10 - 12/31/17
​Inland Empire Health Plan (IEHP)
​H5640
​02/08/16
​06/15/16
​01/01/11 - 12/31/16
​Inter Valley Health Plan
​H0545
​03/14/16
06/15/16
​01/01/14 - 12/31/16
​L.A. Care Health Plan ​H2643 ​02/29/16 ​06/15/16 ​09/26/13 - 12/31/14
Molina Healthcare of California
H5810
01/27/17
01/30/17
01/01/11 - 12/31/17
Partnership Health Plan of California
H5782
01/28/14
05/13/14
03/01/10 - 12/31/15
SCAN Health Plan
H5425
07/13/16
08/24/16
01/01/11 - 12/31/17
United Healthcare of California/Secure Horizons
H0543
05/23/14
06/16/14
01/01/10 - 12/31/15

 Claiming Scenarios

Last modified on: 4/10/2017 10:20 AM