October 2, 2025
Following are this week’s updates. If you have questions, please contact [email protected].
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Production Procedure Rate Refresh – Week of Oct. 6
CalMHSA has scheduled a procedure rate refresh for the week of Oct. 6 in county production environments. The updates will be applied over two days, based on fiscal year:
- 2024-25 fiscal year procedure rates will be refreshed before start of business on Oct. 8.
- 2025-26 fiscal year procedure rates will be refreshed before start of business on Oct. 9.
Action Item
If your county has added new programs, this is a great opportunity to ensure meta tagging is completed prior to the week of Oct. 6 — helping ensure programs are properly linked to the updated procedure rates.
Opt-Out Option
Counties that would like to either opt out of the production procedure rate refresh or coordinate a different deployment date, should notify Lisa Kirlin ([email protected]) or Khristy Pease ([email protected]) by Oct. 6.
The rate refreshes include a variety of changes; see below for a detailed list of what to expect:
- Creation of new procedure rate records for caregiver procedure codes added to SmartCare: The new procedures were communicated in the August 28 EHR Bulletin and are also available on the Procedure Codes and Licenses spreadsheet located on CalMHSA’s website. Sort by code type “Caregiver/Collateral” to view the full list.
- Corrections:
- Duplicate Modifier Fix: Removal of 22 duplicate modifiers on plan-level rates where the Mode of Delivery is PCIT.
- Latest updates as published in DHCS’s service tables: The full list of updates to the service tables can be found in the Version Changes tab of the service table. A few notable changes include:
- HL Modifier Removal: The HL modifier will be removed from billing codes where HL is not listed as an allowable modifier. When the HL modifier is listed as an allowable modifier it will only be inserted on rates records linked to an associate or a waivered psychologist degree.
- Telehealth Modifiers: Plan-level rate records for T2021 and T2024 will no longer append the 93 or 95 modifiers. Instead, the SC modifier will be used for telehealth services with these billing codes.
Note: If you have experienced a recent increase in denials for CO96/N216, this may be due to the HL or 93/95 modifiers being incorrectly attached to billing codes.
CARE Act Referral Update on BHIN 25-012
As part of working on BHIN 25-012 analysis and implementation, CalMHSA has created a scanned document type for “CARE Act System Referral (scanned).” This document is only viewable/editable by CalMHSA sys admin, county affiliate sys admin, and CARE Act add-on user roles.
In addition, a delete permission has been created for this document. Only sys admins can delete once the document has been saved. The CARE Act add-on user role has permission to delete the document before the document is saved, but not after it has been saved.
CalMHSA will be working on adding a SmartCare version of the CARE Act System Referral document, using the template enclosed with BHIN 25-012. We will also be working on a workflow where an agency within SmartCare can create and “send” the referral to the county’s CARE Act program all within SmartCare. There is not an ETA at this point.
CalMHSA is also working on improving the filter in the Documents (Client) list page related to the CARE Act, adding a new folder called “CARE Act Program Documents” that can be used to store items such as the CARE Act System Referral, CARE Act System Referral (scanned), CARE Act Court Document (scanned), and the CARE Act Petition (scanned). Other plans include eliminating duplicates of the CARE Act narrative note.
Upcoming CalMHSA Connex Maintenance
All Connex users were sent an email notification about upcoming maintenance to the Connex site on Oct. 5 from 7 a.m. to 7 p.m. Please plan accordingly for this maintenance window and contact [email protected] with any questions.
DHCS Mental Health Screening Tools Update
CalMHSA has been working on development to address BHIN 25-020. This development is in QA systems now, with a few remaining issues to be addressed. Once those issues have been resolved, counties will be notified that they can begin testing.
Updates will include:
- Adding a section for “Override.” This section includes justification for the override and the new recommendation. This language is pulled straight from the BHIN.
- Permissioning the “Override” button to only LPHAs
- Updating the related reports to include the override option (Coming soon)
Knowledge Base articles for these documents will be updated once the development goes to production environments.
Contract Provider Charge Export: Incorrect Charge Unit Calculation for Rolled-Up Claims
An issue was identified and resolved in the Contract Provider Charge Export related to how Charge Units were populating for claims rolled up in SmartCare due to the Same Day Billing rule. The Same Day Billing rule consolidates charges for the same procedure, performed by the same clinician, on the same date of service. When these charges are batched, the total number of charge units should reflect the sum of all rolled-up charges.
However, the identified issue caused the export to incorrectly pull the charge unit from just one of the individual charges within the rolled-up claim, rather than using the total number of units shown in the claim line item. This issue was introduced with the updates released on Aug. 11 and has since been corrected in Production environments as of Sept. 29. The Invoice Reconciliation Tool located under Contract Provider Invoicing Process can be used to identify any services that may have been invoiced correctly due to this issue.