August 2019 – Claims corner newsletter

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GO447—New HEDIS Tip Sheet (Provider Alert 7.11.2019)
The annual HEDIS Provider Tip Sheet is a tool used to inform providers of the value set codes published at the national level by the measure steward (the National Committee for Quality Assurance). The most recent version of the Provider Tip Sheet is posted on DRE.

In the new HEDIS tip sheet we now include only those codes payable by the Department of Health Care Services (DHCS); medications found on the HPSJ preferred drug list. Due to changes in reimbursement, G0447 may NOT be used for children.

Cactus Application Manager (Provider Alert 6.4.2019)
Testing with a set of provider volunteers has begun for this new electronic credentialing tool. When testing is complete, benefits will include:

  • No more complicated, error-prone process to gather data from providers — forms & applications will auto-populate with your information.
  • Automated Processes — existing providers will be notified when they are due for recredentialling. HPSJ will be able to set automatic reminders and receive email alerts when a provider completes an application.

Fraud, Waste, and Abuse—Annual Required Training
(Provider Alert 07.24.2019)

Under legal requirements overseen by the federal Centers for Medicare & Medicaid Services (CMS), 42 C.F.R. §422.503 and 42 C.F.R. §423.504, you are required to either complete the FWA training offered on the HPSJ website and send HPSJ a signed attestation, or attest that you have completed another, acceptable FWA training. To help you meet the annual FWA training requirement, HPSJ is now providing this training, at For your convenience, you now are able to digitally sign the attestation form.

DHCS Encounter Requirement —
NDC (National Drug Code) now required

(Provider Alert 8.5.2019)
Effective July 1, 2019, all claim submissions, regardless of date of service(s) on the claim, should include the NDC when billing drug-related codes. Without the required NDC, the claim line will be denied; a resubmission of a Corrected Code will be required.

Posted on August 20th, 2019 and last modified on August 21st, 2019.