June 27, 2024
Following are this week’s updates. If you have questions, please contact [email protected].
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Important Update: Changes to Procedure Codes Effective July 1
Please note the following changes to procedure codes beginning July 1:
- Procedure code 127 (Psychiatric Hospital Inpatient Admin Day) will be inactivated. Procedure 124 (Inpatient – Admin Day) should be used as its replacement.
- Procedure codes 130 (Crisis Residential Day – Older Adult) and 131 (Crisis Residential Day – Adult) will be inactivated. Procedure code 132 (Crisis Residential Day) should be used as their replacement.
- Procedure code 133 (Adult Residential Day – Older Adult) will be inactivated. Procedure code 134 (Adult Residential Day) should be used as its replacement.
CalMHSA is preparing scripts to automate these updates across relevant programs and services, including adjustments for specific bed-day codes. Questions can be directed to [email protected].
Clarification From DHCS on CalAIM Dashboard Funding Sources
CalMHSA met last week with the Department of Health Care Services regarding the CalAIM dashboard and the approved/paid/denied amounts from the Funding Source tab – an issue counties have inquired about as they compare the dashboard to the totals in SmartCare or in PowerBI.
DHCS shared these details about the Funding Sources tab:
Total Approved: The amount that Short Doyle will adjudicate as what has been approved
- Includes paid and unpaid funds
- If a service is overbilled, only the amount approved will be reflected in this total. For example, if a service was submitted with a rate of $100 but the service was approved at $75, only $75 will be added to the Total Approved.
Total Paid: Includes payments at the point an 835 has been created
- This will not include upcoming scheduled payments.
- If a county receives a warrant but did not receive the associated 835, the payment will not show in the CalAIM dashboard, because the funding source is needed.
Total Denied: Reflects total dollar amount currently denied
- If denied claims are replaced and subsequently approved, then the amount approved for the replaced claims will be deducted from Total Denied and moved to Total Approved.
General Notes
- The data reflected in the dashboard reflects all claims submitted through the Saturday preceding when the dashboard was created.
- Counties that would like to reconcile their CalAIM dashboard can email MedCCC and ask for a breakdown of what was approved, paid and denied by 835s.
CalMHSA Advocating for Adjustments to TADT Tools
On June 12, CalMHSA received the attachments accompanying BHIN 24-020 for the FY 2024-25 Network Adequacy Certification period, which are due Aug. 1. CalMHSA is aware of the challenges associated with submitting the DMC-ODS TADT tool due to modifications made in May 2024 after the close of the reporting period of July 1, 2023 – March 31, 2024.
To be able to report in August, counties should continue to use the Timeliness Tracking Forms used to create the SmartCare TADT report.
CalMHSA will review the TADT documents and the corresponding reports to make any changes necessary. We understand that some information requested in the new TADT workbooks is not in the current TADT documents and, therefore, will not be able to be reported.
Additionally, we will be closely collaborating with the County Behavioral Health Directors Association (CBHDA) to identify future modifications needed for the Network Adequacy Certification Tool certification year 2025-26 before the upcoming reporting period begins.
Together with CBHDA, CalMHSA has been actively discussing the impact of changes made to the TADT tools and advocating to the Department of Health Care Services for necessary adjustments.
New License and Associated Procedure Codes Added
CalMHSA has added a license – RDN – for registered dieticians, along with the following procedure codes for documentation:
- 317 – Dietician Evaluation Note: Used by dieticians to record their evaluation and assessment
- 315 – Dietician Progress Note: Used by dieticians to record their progress note.
These codes are nonbillable and currently use a narrative note template but will be shifted to the new medical note template once it is deployed. Procedure Code Definitions have been updated.
Updated Requirements for Surescript Medication History
Streamline has updated the requirements for retrieving Surescript Medication History. Details are available on the website.
New functionality in the EHR – and what you need to know about it – is available here.
Upcoming Initiatives
See the EHR Product Team’s ambitious upcoming initiatives in this list, updated weekly as products and priorities evolve — and sortable by topics like medical, clinical billing and more.
| Event Name | Date | Time | Registration Link |
| CalOMS Weekly Discussion | 6/28/24 | 12:00 pm – 1:00 pm | Register |
| Reports Workshop | 7/3/24 | 10:00 am – 11:00 pm | Register |
| CalOMS Weekly Discussion | 7/5/24 | 12:00 pm – 1:00 pm | Register |
| County Shared Decision Making Meeting: Contingency Management | 7/8/24 | 10:00 am – 11:00 pm | Register |
| Billing Office Hours | 7/11/25 | 10:00 am – 11:00 pm | Register |
| State Reporting Review | 7/11/24 | 12:00 pm – 1:00 pm | Register |
| CalOMS Weekly Discussion | 7/12/24 | 12:00 pm – 1:00 pm | Register |