Attention: ASH Contracted Practitioners
August 30, 2018
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).