81 Comments

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  68. Hi, I’m a Program Liaison at the TB Branch, and have been keeping up with Medi-Cal’s decision to reimburse health care delivered through telehealth. So far I haven’t heard of any programs that have been successful getting reimbursement for eDOT. One jurisdiction is working with their county Medi-Cal supervisor to resubmit their claims.

    I will share information from any TB program that is able to get reimbursed. Please let me know about your challenges, too. If no one is successful in getting reimbursed soon, I will try to contact someone at Medi-Cal for advice.

    Reply
    • The Department of Health Care Services (DHCS) has identified a claims processing issue affecting Local Educational Agency claims. The issue caused claims billed with modifier 95 to erroneously deny. This issue affects claims with dates of service on or after July 1, 2019. No action is required of providers. DHCS and the California MMIS Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regarding this issue. It is believed the problem has been addressed and eDOT claims should go through now.

      Medi-Cal is processing claims which were previously denied, and claims do not need to be resubmitted; however, if local TB programs continue to have problems, contact Stephanie Spencer in the CDPH TB Control Branch (stephanie.spencer@cdph.ca.gov}

      Reply

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