Attention: ASH Contracted Practitioners
August 30, 2018

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From the Managed Care & Insurance Committee

ASH has been sending notice to their contracted providers regarding eligibility to treat Medi-Cal or dual eligible (Medi-Medi) members in those programs administered by ASH. The notice states that: “to receive reimbursement for services to Medi-Cal members, practitioners must be registered with the Department of Health Care Services (DHCS) or through a similar process offered by a Managed Care Organization (MCO), such as ASH, by 12/31/18. ASH has provided an enrollment form to enroll directly with them by 9/30/18.

ASH did not provide the information that the requirement to see Medi-Cal or Medi-Medi patients is strictly voluntary, and there is no requirement to see these patients. CalChiro has confirmed with ASH practitioner contracting representatives that enrollment is voluntary and that contracted providers will not be penalized if they opt out of accepting Medi-Cal enrollees. As a ASH contracted practitioner, be aware that if you choose to not participate in these Medi-Cal plans and you accept a patient who is dual Medi-Medi eligible AND who also is a Qualified Medicare beneficiary, you will not be able to bill the patient for co-pays or any deductible amounts for covered services.

The affected plans are listed on page 110 of Attachment D-1 of the American Specialty Health Plans of California, Practitioner Services Agreement. They include:
 

  • Anthem Blue Cross Cal MediConnect Plan
  • Brand New Day Medi-Cal HMO
  • Care 1st Health Plan Medi-Cal HMO
  • Kaiser Permanente Medi-Cal
  • LA Care Health Plan Medi-Cal HMO
  • SCAN Health Plan Medi-Cal HMO

If you have any questions, please contact the ASH Practitioner Contracting Department (800-972-4226, option 4).

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