CalOptima Health Rated as a Top Medi-Cal Plan in California |
CalOptima Health is a top Medi-Cal plan in California, receiving a rating of 4 out of 5 in the National Committee for Quality Assurance (NCQA) Medicaid Health Plan Ratings 2022. This is the eighth year in a row that CalOptima Health has received this distinction. Medicaid is known as Medi-Cal in California, and no other Medi-Cal plan in the state earned a higher rating than 4 out of 5.
“CalOptima Health’s mission is to serve member health with excellence and dignity,” said Michael Hunn, CEO of CalOptima Health. “The NCQA rating shows that we are fulfilling that mission no matter the challenges of the pandemic. Our provider partners have sustained their commitment to quality care for a remarkable eight years, and our community is healthier because of their dedication to members.”
NCQA assesses Medicaid plan quality based on 43 clinical measures related to both preventive care and treatments. Preventive measures report whether members get services to keep them healthy and treatment measures gauge whether members receive appropriate care in response to illnesses and chronic diseases. NCQA also evaluates a plan based on five customer satisfaction dimensions, such as getting care quickly and rating of health plan.
“Day in and day out, Orange County’s dedicated providers demonstrate the quality of care that’s possible through a community-based health plan,” said Richard Pitts, D.O., Ph.D., Chief Medical Officer. “By strictly focusing on doing what’s best for the member, we achieve our high-quality standards and make our ‘Better. Together.’ motto come alive.”
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Provider Portal Upgrades Improve Authorization Times |
CalOptima Health has recently implemented several technology upgrades to the Provider Portal as part of our vision to achieve same-day authorizations and real-time claims payments by 2027.
The portal now allows for the intake and hourly processing of urgent authorizations and pharmacy authorizations. Depending on eligibility, providers can also get real-time auto-authorizations for common treatments. At the end of August, CalOptima Health auto-approved 48% of authorizations, up from 3% in October 2021.
The portal now allows providers to see a member’s lab results, medications and condition history in response to provider feedback for a more comprehensive view of a member’s health experience. Additionally, primary care providers can access a member roster to help identify CalOptima Health members in their care.
Learn how to navigate the portal’s features by watching this training video.
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DHCS Addresses Potential Gap in Medi-Cal Coverage for Young Adults |
To maintain continuity of coverage for Medi-Cal members over the age of 26, the Department of Health Care Services (DHCS) will continue their coverage past the end of the COVID-19 Public Health Emergency (PHE) until a planned extension goes into effect.
During the PHE, DHCS maintained coverage for this group as part of federal regulations. But once the PHE ends, DHCS will redetermine Medi-Cal eligibility, and this coverage will end.
Starting in 2024, the state has approved extending Medi-Cal coverage to individuals 26–49 years of age, regardless of immigration status. To prevent a loss of benefits for those who turned 26 during the PHE and before this expansion occurs, DHCS will continue to provide them with full coverage.
The current PHE is scheduled to end October 13, 2022. However, since the U.S. Department of Health and Human Services has not given its promised 60-day notice, it is anticipated that the PHE will continue until at least January 2023.
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Virtual Continuing Education Workshops Address Childhood Lead Poisoning |
Two virtual workshops in October will cover sources and risk factors for childhood lead exposure, California’s childhood lead screening operations and appropriate interventions. The workshops will feature Jean Woo, M.D., MPH, MBA, Public Health Medical Officer at the Childhood Lead Poisoning Prevention Branch of the California Department of Public Health.
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Medi-Cal Rx Webinar Will Cover Prior Authorizations |
Medi-Cal Rx’s upcoming reinstatement of prior authorization for 11 drug classes is the focus of an upcoming webinar. The hourlong webinar will include a 30-minute presentation and a Q&A session:
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September 23, Noon, Zoom link (No registration is required)
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OneCare Connect Shares Dx Codes for National HIV/AIDS and Aging Awareness Month |
September is National HIV/AIDS and Aging Awareness Month, which brings attention to issues related to HIV among older Americans. In recognition, CalOptima Health’s OneCare Connect program is reminding providers to use these HIV and AIDS diagnosis (Dx) codes.
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APLs Gives Guidance on Eligibility and Enrollment Operations, DHCS Sanctions, Provider Credentialing, Community Health Workers and COVID-19 Treatments and Therapuetics |
Reminder: The current guidelines for COVID-19 treatment and testing can be found in DHCS APL 22-009, while the use of therapeutics to treat COVID-19 is encouraged in Department of Managed Health Care APL 22-017. For more information regarding available COVID-19 treatments and latest updates, please visit the Orange County Health Care Agency’s COVID-19 Therapeutic Recommendations page.
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Policies and Procedures Monthly Update |
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Health Education: Trainings and Meetings |
Click below for a list of training webinars and links happening in September 2022:
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Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- FDA Approves COVID-19 Vaccine for Children 6 Months and Up
- New Approval Messages for COVID-19 Uninsured Group User Guide
- Levofloxacin Added as Clinic Benefit for Family PACT and Medi-Cal Programs
- Rate Update for Contraceptive Vaginal Gel
- Radiology Reimbursement Rates Updated Retroactively
- Family PACT and Medi-Cal Programs End Date Essure
- Reminder: Annual Cognitive Assessment Added as a Medi-Cal Benefit
- Reminder: Discontinued and Invalid Z Modifiers
- Update: Paper RADs and No Pay Documents
- Billing Issue: E&M Code 99202 with TD Modifier
- PAVE Portal for Family PACT Providers
- Beneficiary Eligibility Verification Reminder
- Monkeypox Services and Reimbursement for FQHC, RHC, HIS-MOA and Tribal FQHC Providers
- Coming Soon: Monkeypox Vaccines as Medi-Cal Benefits
- Coming Soon: Novavax COVID-19 Vaccine Authorization
- Reminder: Introduction of Therapeutic Substance into Mouth and Pharynx Not Restricted to Females
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- CalOptima Health Board of Directors: October 6 at 2 p.m.
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CalOptima Health Joint Provider and Member Advisory committees: xxxxxxxxxx October 13 at 8 a.m.
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Follow Us on Social Media |
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CalOptima Health regularly posts on social media to engage members with heath tips, community resources, event dates, program updates and other pertinent information. Follow the agency on Facebook, Instagram, Twitter and LinkedIn.
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CalOptima Health, A Public Agency www.caloptima.org
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