Recorded December 15, 2022
Starting on January 1, 2023, all patients in Alameda and Contra Costa counties who are dually covered by both Medicare and Medi-Cal (known as “dual eligible” or “Medi-Medi” patients) will be enrolled in a Medi-Cal managed care plan. This means that any dual eligible patients who were covered by Medi-Cal fee-for-service in 2022 will now be enrolled into a Medi-Cal managed care plan effective January 1. This change has no impact on Medicare coverage or reimbursement rates; this change only applies to the Medi-Cal component of coverage for dual eligible patients. The claims submission process and reimbursement are expected to remain unchanged.
To help you better understand this transition, the ACCMA recorded a presentation with officials from the California Department of Health Care Services, which oversees the Medi-Cal program, to review what is changing, why, and how it will impact physician practices.
Some important takeaways about this change include:
- Dual eligible patients with Medi-Cal fee-for-service in 2022 will be enrolled into Alameda Alliance for Health (Alameda County only), Contra Costa Health Plan (Contra Costa County only) or Anthem Blue Cross (both Alameda and Contra Costa).
- Medicare coverage and reimbursement is not impacted by this change
- Billing should be the same:
- For Medicare fee-for-service, submit the claim to Noridian and Noridian will then send it along to the secondary insurer. The remittance for Medi-Cal secondary will now come from the patient’s Medi-Cal managed care plan instead of the state intermediary.
- For Medicare Advantage (MA), submit the claim to the patient’s MA plan and the secondary claim to the patient’s Medi-Cal managed care plan
- You are not required to be a contracted provider with the Medi-Cal managed care plans to submit claims for reimbursement for secondary coverage.