Provider Alerts - October 31, 2018

Proposition 56: Supplemental Payment Update

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Date: October 30, 2018
To: Health Plan of San Joaquin (HPSJ) PCPs and Specialists
From: HPSJ Claims Department
Subject: Proposition 56: Supplemental Payment Update
Business: Medi-Cal

Great News:
The Department of Health Care Services (DHCS) proposal for a one-year extension to the
supplemental payment for certain physician services using Proposition 56 Tobacco Tax
Funds has been approved for the 2018-19 State Fiscal Year.

  • The supplemental payment amounts are fixed amounts to be paid per claim.
  • Preventative codes have been added and the rates for most of the existing codes under Prop 56 have been increased and are identified by the CPT codes below.
  • Note: Those codes marked with [*] are new codes that will get Proposition 56 reimbursements.

These Prop 56-related codes also are great for your HEDIS scores and reimbursements!

Managed Care Plans (MCP) are not expected to receive the additional funding for several months. However, Health Plan of San Joaquin (HPSJ) will start paying the updated supplemental amounts soon. Once this process begins, you will start receiving the additional amount through the regular reimbursement process.

Any claim with a date of service 07/01/2018 forward that has already processed to pay by HPSJ and did not include the new supplemental payment amount will be reprocessed for an additional payment.

Moving forward – Any new incoming claims with a date of service of 07/01/2018 – 06/30/2019 will receive the supplemental payment through normal claims processing and be reflected in the payment made for those codes on your RA. This is the same process we followed for FY 17-18.

Following Page: CPT codes under Proposition 56

CPT

Description

 Directed Payment FY 19

99201

Office/Outpatient Visit New

$18.00

99202

Office/Outpatient Visit New

$35.00

99203

Office/Outpatient Visit New

$43.00

99204

Office/Outpatient Visit New

$83.00

99205

Office/Outpatient Visit New

$107.00

99211

Office/Outpatient Est

$10.00

99212

Office/Outpatient Est

$23.00

99213

Office/Outpatient Est

$44.00

99214

Office/Outpatient Est

$62.00

99215

Office/Outpatient Est

$76.00

* 99381

Preventative Med Service/New

$77.00

* 99382

Preventative Med Service/New

$80.00

* 99383

Preventative Med Service/New

$77.00

* 99384

Preventative Med Service/New

$83.00

* 99385

Preventative Med Service/New

$30.00

* 99391

Preventative Med Service/Est

$75.00

* 99392

Preventative Med Service/Est

$79.00

* 99393

Preventative Med Service/Est

$72.00

* 99394

Preventative Med Service/Est

$72.00

* 99395

Preventative Med Service/Est

$27.00

90791

Psychiatric Diagnostic Eval

$35.00

90792

Psychiatric Diagnostic Eval
w/Medical Services

$35.00

90863

Pharmacologic Management

$5.00

* New codes that will get Proposition 56 reimbursements

Health Plan of San Joaquin is dedicated to providing all members the best health care available in the most effective and efficient manner. Thank you for being one of our valued partners. If you have questions, please contact our Customer Service Department at 209-942-6320.

REMINDER: If not already submitting your billings electronically (EDI) and not receiving your payments deposited directly into your bank account (EFT) and receiving your remittance advice (RA) electronically (ERA), please call your Provider Services Representative today.

By signing up for EDI, EFT and ERA services, you typically receive your payments 2-3 days sooner instead.

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