CalOptima Health’s Quality Improvement Medi-Cal Grant Program is providing support to health networks, community clinics and CalOptima Health Community Network (CHCN) primary care providers for the planning and implementation of quality improvement activities for Medi-Cal members. On September 23, the first round of grants was announced for the following health networks: AltaMed, CHOC Health Alliance, Noble, Optum and Prospect. Grantees from the community clinics and CHCN primary care providers will be announced soon. This grant program was developed in response to the ongoing need for enhanced health care quality and patient outcomes, particularly in underserved communities. This initiative aims to address systemic challenges and disparities within health care delivery systems, fostering innovation, collaboration and sustainability in quality improvement efforts. 

Eight months after the Change Healthcare cyberattack, CalOptima Health has reconnected with the health care technology company and is poised to start processing new remittance advices (RAs) again on October 9.

Following the announcement of the cyberattack in February, CalOptima Health proactively disconnected from Change Healthcare. We also added a 90-day grace period to the 365-day claims deadline and informed providers of alternative options for submitting claims and receiving electronic payments. CalOptima Health was part of a limited reconnection to Change Healthcare in May, but that did not include RAs.

After reconnecting fully with Change Healthcare in August, we worked on processing the backlog of RAs submitted after the February disconnection. We have finished processing all RAs through the end of August, and are now working on those from September. Assuming no further issues, it is estimated that we will return to normal RA operations by October 9.

If you have any questions, please contact the Provider Relations department at 714-246-8600 or providerserviceinbox@caloptima.org.

Attention OneCare providers — The annual election period (AEP) for CalOptima Health’s OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, opens on October 15 and runs through December 7.

To be eligible for CalOptima Health OneCare a member must be:

• Age 21 and older
• Living in Orange County
• Enrolled in Medicare Parts A and B
• Receiving Medi-Cal benefits

Starting in 2025, CalOptima Health OneCare members have two plan options they can select from:

• CalOptima Health OneCare Complete — Our original plan offers $0 copays on medical and hospital services and all covered prescription drugs. It includes many extras, such as a fitness benefit, comprehensive dental, more vision care, a flex card for over-the-counter (OTC) items and groceries and more.
• CalOptima Health OneCare Flex Plus — Our new low-cost plan is designed for flexibility, offering $0 doctor visits and hospital stays. It also includes generous extras such as a larger flex card allowance for OTC items, more vision care, comprehensive dental, a fitness benefit and more.

You can explore the benefits of each plan here. For questions, please contact our Provider Relations department at 714-246-8600 or providerservicesinbox@caloptima.org.

CalOptima Health OneCare providers — The deadline for members to submit reward forms for the OneCare Member Health Rewards program has changed to December 15, 2024. For passive health rewards, such as the Annual Wellness Visit, which do not require a form submission, CalOptima Health will continue as is, but rewards will cease as of December 31, 2024.

We understand health reward forms show a submission deadline of January 31, 2025, but the new deadline is December 15, 2024. CalOptima Health is unable to reward members for 2024 dates of services in 2025, as rewards must be issued in the same calendar year. 

CalOptima Health and UCI School of Medicine partnered for the second year in a row to recognize National Latino Physician Day on October 1 and work toward better representation through education and workforce programs. To honor our valuable physician partners, CalOptima Health celebrated National Latino Physician Day with a full-page ad in the Orange County Register on Sunday, September 29. The day highlights the fact that while 19% of the United States’ population — and 39% of California's population — is Latino, only 6% of U.S. physicians are Latino. Research shows that the disparity can affect health care access and outcomes. To learn more, visit www.nationallatinophysicianday.com.

CalOptima Health is committed to providing access to care for members, which is why we are announcing a brief change in the locations available for sobering center services. As of September 18, 2024, sobering center services at the Be Well OC Orange Campus (265 S. Anita Drive, Orange, CA 92868) are temporarily unavailable.

During this time, sobering center services will continue to be available at the Phoenix House location:

Phoenix House

1207 E. Fruit St.

Santa Ana, CA 92701

714-461-0569

Weekday Hours: Monday–Friday, 8:30 a.m.–5 p.m. — 714-953-9373, ext. 2

After Hours: Monday–Friday, 5 p.m.–8:30 a.m./Saturday and Sunday, 24/7 — 714-752-0854

Sobering center services will resume at the Be Well OC Orange Campus soon, with operational oversight by the Orange County Health Care Agency. When the reopening date is confirmed, an announcement will be shared, and referring organizations will again be able to direct CalOptima Health members for sobering center services to both the Be Well OC Orange Campus and Phoenix House locations.

Providers can get unlimited free cases of life-saving naloxone for their patients from CalOptima Health at an in-person event on Friday, October 11, or through delivery directly to their offices. This Naloxone Distribution Event is part of our Drive to Revive campaign. Sign a simple distribution agreement and receive an unlimited number of cases that contain single-use, prescription-strength nasal spray doses of Kloxxado, naloxone’s brand name.

Naloxone can potentially save lives if administered to someone having a known or suspected opioid overdose or fentanyl poisoning. Naloxone is easy to use, requires no special training and is safe even for use on children. CalOptima Health has put together information and a training video at www.caloptima.org/naloxone.

Community Naloxone Distribution Event

• Friday, October 11, 2024
• Pick up between 9 a.m. and Noon
• CalOptima Health | 505 City Parkway West, Orange, CA, 92868

Please register in advance by October 4 using this link.

Providers who cannot attend the distribution event can also order naloxone through CalOptima Health by following the steps below:

1. Email naloxone@caloptima.org with the name and email address of your organization’s authorized representative. We will then send that person a Naloxone Distribution Agreement via DocuSign.
2. Once you have the agreement, identify the number of cases you want.
3. Sign and return the agreement.
4. Receive the naloxone. CalOptima Health will deliver the naloxone during the business hours identified on the DocuSign.

For questions about the event, email holly.mendez@caloptima.org. For questions about the naloxone distribution program, email naloxone@caloptima.org.

We encourage providers to take a few minutes to give us feedback on how we can improve through our 2024 Provider Satisfaction Survey.

Please complete the survey by October 25 using this link. Your responses will aid us in understanding your experience with both CalOptima Health and our contracted health networks.

Your practice’s opinions are an important source of information for us to identify needs and deliver solutions while streamlining our work together. The survey results will be used to improve the level of service provided by CalOptima Health and will be shared with our health networks. Thank you in advance for responding to the survey. We appreciate your time and look forward to receiving your valuable feedback.

CalOptima Health and AltaMed Health Services—AHN have announced a new agreement regarding financial responsibility for certain claims. Effective November 1, 2024, AHN will assume financial responsibility for all facility claims related to emergency room, inpatient or outpatient surgery services rendered to CalOptima Health Medi-Cal patients assigned to AHN as their health network. 

Due to this change, claims with a date of service beginning November 1, 2024, or later should be directed to AHN. 

For electronic claims, there are two Payer IDs available: 

• ALTAM or 95712 — Please consult with your biller/clearinghouse to determine which Payer ID you should use. 

For paper claims and other correspondence, the address is: 

AHN 

c/o Altura MSO Inc. 

P.O. Box 7280 

Los Angeles, CA 90022-7280 

If you have any additional questions, please contact AHN’s provider support line at 855-848-5252. 

Providers are invited to a continuing education webinar at Noon on Wednesday, November 6, 2024, to learn how to complete the Alcohol and Drug Screening, Assessment, Brief Interventions, and Referral to Treatment (SABIRT) for substance use disorders (SUDs). 

The 90-minute course will cover using appropriate tools to identify and address SUDs, risk considerations when assessing substance use, potential cultural barriers, and strategies for referring patients to treatment. Providers can earn 1.5 continuing medical education and continuing education credits for attending. 

Please register for the webinar by Monday, November 4, by visiting https://bit.ly/3Z29tvO. If you have questions, please contact Quynh Tran or Bao Anh Le at continuingeducation@caloptima.org. 

CalOptima Health has partnered with SullivanLuallin Group (SLG) to improve the patient experience. Throughout October, SLG will offer three lunch-and-learn sessions designed for physicians and their office staff.

Register now for one of the following sessions:

• Wednesday, October 16, 2024, Noon–1 p.m. — Building a Highly Effective Health Care Team. This program covers leadership, community and accountability, and suggests strategies to make your health care team more cohesive, collaborative and effective. Register using this Zoom link.
• Wednesday, October 23, 2024, Noon–1 p.m. — Improving Service Excellence Through Successful Telephone Communication. This program covers improving the communication skills of front desk and scheduling staff, including effectively managing telephone calls, improving office staff practices and building first impressions of your office. Register using this Zoom link.
• Wednesday, October 30, 2024, Noon–1 p.m. — Improving Patient Access and Flow. This program covers how to have an effective front office team, including ensuring timely and efficient access to care for patients, streamlining and improving patient flow, and implementing practical solutions to enhance access and flow. Register using this Zoom link.

Providers are invited to attend a two-day conference discussing mental health issues among Orange County’s Vietnamese population.

The International Vietnamese Mental Health Association is hosting “The State of Vietnamese Mental Health: Past, Present, and Future” on October 3–4, 8 a.m.–4:30 p.m. each day, at the Orange County Behavioral Health Training Center, 750 The City Drive S., Orange, CA 92868.

The conference includes workshops and symposiums with professionals, students and community members discussing Vietnamese mental health topics. CalOptima Health Medical Director Thanh-Tam Nguyen, M.D., MS, will be the keynote speaker on October 4.

Providers interested in attending can get more information and register using this link. For questions, email conference@vietnamesementalhealth.org.

Providers are invited to attend the Creating Health Bootcamp to learn how to maintain and optimize their patients’ and their own health. 

CalOptima Health is sponsoring the 10-week virtual seminar series presented by the University of California, Irvine’s Susan Samueli Integrative Health Institute. Participants will learn the latest evidence-informed approaches to health maintenance and receive practical tools for their clinical practice. 

The boot camp is open to all Orange County physicians and clinicians, and attendees can earn 10 continuing medical education credits by attending.  

The one-hour seminar sessions will be held on

Zoom, starting on October 9, 2024, at Noon. 

Topics will include           

• Health and Wellness: What’s That Really Mean? 
• Clinician Happiness: How Does it Work?          
• Nutrition and Diet: What the Best Way to Eat?  
• Culinary Medicine
• Depression: What You Need to Know  
• Anxiety in You and Your Patients  
• Cognitive Behavioral Motivation  
• Tips for Better Sleep  
• Strategic Thinking for Healthier Living               
• Practical Pointers for Better Daily Health 

To register, please visit SSIH’s Creating Health Bootcamp website. For questions regarding this series, please contact ssihieducation@hs.uci.edu.

The Department of Health Care Services’ (DHCS) External Quality Review Organization conducts an annual timely access survey of all managed care plans (MCPs) to ensure compliance with provider availability and wait time standards for urgent and non-urgent appointments among network provider types. The survey consists of calling a randomized sample of network providers by each MCP’s county/region–based reporting unit. In addition, DHCS provides CalOptima Health with a plan-specific Quarterly Monitoring Response Template and Medi-Cal Managed Care Quarterly Monitoring Performance Report as part of the ongoing performance monitoring of Medi-Cal MCPs.

CalOptima Health continuously monitors and evaluates our members’ ability to obtain prompt health care services, including in-office wait times, as required by DHCS. As indicated in CalOptima Health’s Access and Availability Policies, GG.1600 – Access and Availability Standards, in-office wait times should not exceed 45 minutes before a member is seen by a provider.

Thank you for continuing to ensure our members have access to timely health care. To continue assisting you with this effort, CalOptima Health is providing this list of timely access standards. If you have any questions or would like to speak with a Provider Relations representative, please call 714-246-8600 or email providerservicesinbox@caloptima.org.

Federal and state regulations require CalOptima Health to provide interpreter services to members with limited English proficiency. Limited English proficient (LEP) members include those who have a limited ability to read, speak, write or understand English.

Providers may request interpreter services for their CalOptima Health patients with limited English proficiency. Providers may request either telephonic or face-to-face interpreter services, depending upon the situation.

For help in identifying your patient’s preferred language, see the Providers section of the CalOptima Health website.

How to Request Interpreter Services:

1. Verify the member’s eligibility and identify if the member is enrolled in a health network or CalOptima Health Direct.

2. Determine whether telephonic or face-to-face interpreter service is needed.

a. Telephonic interpreter service is recommended for urgent situations or short and simple conversations. This service is available 24/7.

b. Face-to-face interpreter service, including American Sign Language, is recommended when complicated or extensive explanation of treatment or symptoms is required. This service is available for scheduled medical appointments in an ambulatory setting and requires at least five working days’ advance notice.

3. Please have the following information ready at the time of the request:

a. Member’s name

b. Member’s Card Identification Number

c. Member’s gender

d. Member’s age

e. Date of appointment

f.  Time of appointment

g. Language needed

h. Approximate duration

i.  Type of visit

j.  Name of doctor/facility

k. Address of appointment/location

l.  Phone number of appointment/location

4. If the member is in CalOptima Health Direct or CalOptima Health Community Network, call CalOptima Health’s Customer Service department at 714-246-8500. Prior authorization is not required.

5. If the member is in a health network, please use this list to contact the member’s health network after verifying eligibility. The member’s health network will work with you and the member to coordinate all interpreter services.

For additional information, please see Section N7 of the Provider Manual on the CalOptima Health website.

When submitting supporting documentation through the CalOptima Health Provider Portal, please remember that file attachment names have a 50-character limit.

To ensure smooth processing of your authorizations:

• Keep file names concise
• Consider that spaces and special characters count in the 50-character limit
• Rename files if needed before uploading

Following these guidelines will help prevent submission errors and delays in processing your authorizations.

As a reminder, providers are required to report when members are impacted by natural and man-made disasters such as flooding, earthquakes, fires, etc. To report such conditions, please contact the Provider Relations department at 714-246-8600 or providerservicesinbox@caloptima.org. 

Click on the link below to find an outline of changes made to CalOptima Health policies and procedures during August 2024. The full description of the policies below is available on CalOptima Health’s website at:

www.caloptima.org/en/ForProviders/Resources/ManualsPoliciesandGuides.aspx.

Policies and Procedures Monthly Update

Click below for training webinars and meetings happening in October 2024:

Health education webinars

• CalOptima Health Board of Directors: October 3 at 2 p.m.
• Joint Meeting of the Provider and Member Advisory Committees: October 10 at Noon

All meetings have an option for virtual attendance. Visit the CalOptima Health website for more information.