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Provider Manual For questions and Gold Coast Health Plan information, please call 1 www .goldcoasthealthplan.org-888-301 -1228 To Imp rove the Hea lth of Our Members Through Provision of the Best Poss ible Q uali ty C 2015 ar e a nd Se rvi ces PROVIDER MANUAL 1-888-301-1228 www.goldcoasthealthplan.org Table of Contents Page SECTION 1: INTRODUCTION 8 Gold Coast Health Plan Mission Statement 8 Organization of the Provider Manual 8 Provider Web Portal 8 Other Resources on the GCHP Website 8 SECTION 2: GLOSSARY OF TERMS 9 SECTION 3: PROVIDER APPLICATION CREDENTIALING AND CONTRACTING 17 Initial Application Process Re-credentialing Information 17 Additional Requirements for CHDP, CPSP, HIV/AIDS 17 CAQH and Gemini Diversified Service 17 Facility Site Review for Primary Care Office Locations 17 Notification of Adverse Actions Taken Against You or Your Staff 18 Appealing Adverse Decisions by the Credentials Committee 18 Debarment, Suspension, Ineligibility or Voluntary Exclusion 18 Fraud, Waste and Abuse Reporting Program 19 Provider Contract Termination 19 Continuity of Care 19 SECTION 4: CALIFORNIA STATE PROGRAMS 20 Coordination of Care 20 California Children’s Services (CCS) 20 Child Health and Disability Prevention (CHDP) 21 Comprehensive Perinatal Services Program (CPSP) 21 Members with Developmental Disabilities or Developmental Delay 22 Early Start Program for Developmentally Disabled Infants and Toddlers 22 Community-Based Adult Services (CBAS) 23 Health Insurance Premium Payment Program (HIPP) 24 Objectives of HIPP 24 Eligibility and Documentation Requirements for HIPP 24 HIPP Responsibilities – GCHP vs. Ventura County 25 Vision Services 25 Gold Coast Health Plan www.goldcoasthealthplan.org 2 Carved-Out Services and Limited Benefits 26 Audiology 27 Hearing Aids 27 Behavioral Health Care 27 Chiropractic 28 SECTION 5 - MEDI-CAL ELIGIBILITY 29 Categories of Medi-Cal Eligibility: Aid Codes 29 Types of Medi-Cal Coverage: Levels of Benefits 29 Full-Scope Medi-Cal 29 Limited-Scope or Restricted Medi-Cal 29 Special Programs 29 Share of Cost (SOC) 29 Administrative vs. Regular Member 30 Eligibility and Enrollment and Member ID Cards 31 Selection of a Primary Care Provider (PCP) 31 How to Verify Eligibility 31 Member ID Card 32 Out-of-Area Medi-Cal Beneficiaries 32 Benefits 32 SECTION 6: RESPONSIBILITIES OF THE PCP 33 Access to Care 33 Routine Appointments 34 Physical Examinations 34 Initial Health Assessment (IHA) 34 Individual Health Education Behavioral Assessment (IHEBA) 34 Specialty Care 35 Specialist Responsibilities 35 First Prenatal Visit 35 Preventive Care 35 24/7 Availability 36 Medical Records 36 Access to and Copies of Records 37 Reporting Encounter Data 37 Confidentiality of Information 37 PCP Request for Member Reassignment 38 Non-Emergency Medical Transportation (NEMT) from PCP Office to Hospital 38 NEMT Requests 39 Member Procedures/Rights for Emergency Care 40 Gold Coast Health Plan www.goldcoasthealthplan.org 3 SECTION 7: QUALITY IMPROVEMENT (QI) 41 QI Program Goal 41 Quality Improvement Committee (QIC) 42 External Accountability Set (EAS) Performance Measures 42 Facility Site Review 43 Quality Improvement Projects (QIP) 43 Delegation 43 Annual Audit 44 Audit Process 44 Reporting Requirements 44 Non-Compliance 44 SECTION 8: CARE MANAGEMENT PROGRAM 45 Purpose of the Care Management Program 45 Care Management Process 45 Types of Care Management 45 Members Eligible for Care Management Services 46 Care Management Program Goals 46 Referrals to GCHP Care Management 46 SECTION 9: SERVICES REQUIRING PRIOR AUTHORIZATION 47 Medical Services Requiring Prior Authorization 47 Self-Referral: No Authorization Required 48 Post Stabilization Services 48 Administrative Members 49 Family Planning and Sensitive Services: No Prior Authorization Required 49 How to Submit a Request for Prior Authorization 49 Member Requests 50 Routine Pre-Service Requests 50 Expedited/Urgent Requests 50 Out-of-Area and Out-of-Plan Referrals 50 Specialist Referrals 51 Post-Service (Retroactive) Authorization Requests 51 Authorization Request for Ancillary Services 52 NEMT Service 52 Hospital Inpatient Services 52 Emergency and Urgent Admissions Do Not Require Prior Authorization 52 Hospital Observation 53 Nursing Facilities 53 Nursing Facilities Authorizations 53 Nursing Facility Admission Notification 54 Gold Coast Health Plan www.goldcoasthealthplan.org 4 Monthly Census Notification Process 54 Other Health Coverage (OHC) 54 Reauthorization Request 54 Long-Term Care (LTC) 54 Short-Term Skilled Nursing 55 Intermediate Care 55 Sub-Acute Level of Care 55 Hospice Care 55 Serious and Complex Medical Conditions 55 Standing Referrals to an HIV/AIDS Specialist 56 Obtaining a Second Opinion 56 Status of Authorization Requests 57 Deferrals and Denials 57 Assistance with Referral Consultation Requests 57 SECTION 10: CLAIMS AND BILLING 58 How GCHP Claims are Paid 58 Electronic Data Interchange (EDI) 58 Paper Claim Submission 59 Clinical Submission Category 59 Claims Processing 60 Claim Return for Additional Information 60 Timely Filing Requirements 60 Claims Payment 60 CHDP Claims Submission 61 Pharmacy Claims 62 Claim Forms Used by Different Types of Providers 62 Transition to ICD-10 63 SECTION 11: COORDINATION OF BENEFITS 64 Dual Coverage by Medicare and Medi-Cal (Medi/Medi) 64 Medicare/Medi-Cal (Medi/Medi) Crossover Claim Process 65 Share of Cost (SOC) 66 Examples of Share of Cost: Medi-Cal and Medicare 66 GCHP Members with Veterans Benefits 66 SECTION 12: MEMBER SERVICES 67 Member Services Department and Staff 67 SECTION 13: CULTURAL AND LINGUISTIC SERVICES 68 Language Access Program Services 68 Cultural and Linguistic Services Overview 68 Gold Coast Health Plan www.goldcoasthealthplan.org 5 Telephonic Interpreting Services 68 Face-to-Face Interpreting Services 68 Sign Language Interpreting Services 68 How to Request Interpreter Services 68 Cultural and Linguistic Services 69 Cultural and Linguistic Materials 69 SECTION 14: HEALTH EDUCATION 70 Health Education Contract Requirements for Plan Providers 70 Staying Healthy Assessment (SHA) 70 Health Promotion and Disease-Prevention Programs 70 • Weight Management and Physical Activity • Breastfeeding Support • Prenatal/Post-Partum Care • Smoking Cessation • Urgent Care Brochure • MyPlate • Rethink Your Drink • Centers for Disease Control and Prevention (CDC) Women’s Health 71 Health Promotion Materials 71 Materials on Other Topics or in Different Languages 72 Outreach to Members and Providers 72 Providers Order Form 72 Provider Training 73 Outreach Services 73 SECTION 15: PHARMACY 74 Drug Formulary 74 Step Therapy Protocols 74 Prior Authorization Requirements 75 Formulary Exceptions 75 SECTION 16: OUTPATIENT CLINICAL LABORATORY AND IMAGING SERVICES 76 Overview of Outpatient Clinical Lab and Outpatient Imaging Centers 76 Clinical Lab Specimens and Drawing Stations 76 Outpatient Imaging Centers 76 Lab Tests Performed in Provider’s Office 76 List of Laboratory Codes and Descriptions 77 Gold Coast Health Plan www.goldcoasthealthplan.org 6 SECTION 17: RESOLUTION OF DISPUTES AND GRIEVANCES 78 Provider Disputes 78 Provider Dispute Resolution (PDR) Process 78 Provider Grievances 79 Member Grievance and Appeals 79 Provider Responsibilities 80 Expedited Review/Appeal 80 State Fair Hearings 80 Member Rights in the GCHP Grievance Process 81 SECTION 18: FRAUD WASTE AND ABUSE 82 Purpose 82 Policy 82 Definitions 82 Procedure 83 • Training of GCHP Staff and Provider Network • Identification of Fraud, Waste or Abuse • Reporting of Fraud, Waste or Abuse • Investigation and Research • Monitoring • Forms • References SECTION 19: FORMS AND RESOURCES 86 List of GCHP Forms to Review, Download and Print 86 • Claims • Health Services • Member Services • Provider Relations Forms posted on GCHP’s website: www.goldcoasthealthplan.org APPENDICES 88 Appendix 1: Function of Committees and GCHP Staff 88 Appendix 2: FAQs about Claims and Electronic Billing 90 Appendix 3: Financial Disclosure and Reporting Requirements 94 Appendix 4: FAQs from Members on Complaints/Grievances 95 INDEX 98 Gold Coast Health Plan www.goldcoasthealthplan.org 7 SECTION 1: INTRODUCTION Gold Coast Health Plan Mission Statement “To improve the health of our Members through the provision of the best possible quality health care and services.” Welcome to Gold Coast Health Plan Gold Coast Health Plan (GCHP) is a County Organized Health System (COHS) that administers the Medi- Cal program in Ventura County. The COHS is governed by the Ventura County Medi-Cal Managed Care Commission (also referred to as VCMMCC or “the Commission”) which is comprised of 11 members representing providers, clinics, hospitals, service agencies, elected officials and the public. There are two collaborative groups that report to the commission: the Provider Advisory Committee (PAC) and the Consumer Advisory Committee (CAC). The commission meets monthly to review local concerns about health care issues, receive advisory input, and revise GCHP policies, as appropriate. GCHP’s policies are responsive to local input due to the Plan’s local governance and operations. Organization of the Provider Manual This Provider Manual describes operational policies and procedures of GCHP, which is referred to throughout the manual as GCHP or the Plan. Topics covered are included in the Table of Contents at the beginning and Index of Topics at the end of the Provider Manual. You also may access this Provider Manual online by visiting GCHP’s website at www.goldcoasthealthplan.org. For your convenience, a list of forms you may require
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