department of health services · related to meds. eo should the meds/fame cut-off schedule fall on...
TRANSCRIPT
State of California-Health and Human Services Agency
Department of Health Services
Calif)rniaDeportment ofHeath Services
SANDRASHEWRYDirector
ARNOLDSCHWARZENEGGERGovernor
DATE:
MMCD All Plan Letter 05011
TO: ALL MEDI+CAL MANAGED CARE HEALTH PLANS
SUBJECT: 2005 -2006 MANAGED CARE PLAN (MCP) MEDS/FAME CUTOFF ANDPROCESSING SCHEDULE
This letter is to share with you the 2006 (MCP) MEDS/FAME Cutoff and Processingschedule. The encloseq schedule covers the period of December 2005 throughJanuary 2007. A copy qfthe updated outline of MCP's FAME Responsibilities is alsoincluded. I
These cutoff dates and timelines are established by the California Department of HealthServices (CDHS), Information Technology Services Division (ITSD) and are critical toensure timely processing of eligibility files and data. When applicable, it is imperativethat all enrollments and disenrollments by any media (tape/diskette/hardcopy) bereceived on a weekly basis by CDHS. Medi-Cal MCP contractors must adhere to theenclosed cutoff dates arid timelines allowing adequate processing time to insure timely
payment. II j
In addition to the MEDS cutoff dates, the enclosed schedule includes the run dates forthe monthly MEDS/FAME Renewal processes and mail dates for miscellaneous tapesand system-generated r~ports.
If you have any questions or require additional information, please contact your ContractManager or Mr. Roy Joh!nson, Chief of the Systems Support Unit, at (916) 449-5017.
Sincerely,
1J0l~ /lY}. 01 'IVanessa M. Baird, '~~'~~1efMedi-Cal Managed Car~ Division
Enclosures
Medi-Cal Managed Care Division1501 Capitol Avenue, P.O. Box 997413, MS 4400
Sacramento, CA 95899-7413Phone: (916) 449-5000 Fax: (916) 449-5090
Internet Address: www.dhs.ca.QOV
MANAGED CARE PLAN/F AME RESPONSmILITESJannary 2006
l\.llMedi-Cal Managed Care Plans (MCPs) will be responsible for keeping the California Department of Health Services(DHS), Medi-Cal Managed Care Division informed of any Plan changes as described below.
J. NOTIFICATION/REOUEST PROCESS
A. MCPs must notify the Medi-Cal Managed Care Division's Systems Support Unit (SSU) by fax(916-449-5030) of any MCPIFAME changes prior to the 151h of any given month. This receipt deadlineis necessary to meet the Department's Information Technology System Division's (ITSD) processingtime line and make the change effective within 45-60 days. It is requested that MCPssendthe originalcopy of their notification (which includes the original signature of person authorized to submit change) totheir assigned Medi-Cal Managed Care Division Contract Manager. Examples ofMCPIFAME changesfor which notification must be given include, but are not limited to: MCPIF AME MIS Coordinator namechange, address and phone number changes, tape pick up or distribution changes, etc.
1. Please include the following MCP information in the faxed notification:.Plan Name;.Plan Code(s) (Specify all' Active' Plan Codes);.Plan Mailing Address for Tapes, if applicable;.FAME/MIS Contact (Name, Phone/PagelFax Numbers and E-mail Address);.FAME/MIS Backup Contact (Name, Phone/PagelFax Numbers and E-mail Address);.Name(s) ofPerson(s) Picking Up Tapes; and.The nature of the MCPIFAME change.
B.
Medi-Cal eligibility files are uploaded from the Medi-Cal web site by MCPs on a daily basis. To requestaccess to the website, a MCP must submit, through their assigned Contract Manager, a formal writtenrequest and a completed website agreement form. (Note: Please fax a copy of the request to SSU, 916-449-5030). Once this request is received, it is then forwarded to Electronic Data Systems (EDS) whothen incorporates the requested information into a separate contractual agreement with the MCP for thisservice.
Please include the following MCP information in the written request:.Plan Name;.Plan Address (both mailing and billing);.Primary Contact (Name, Phone/Page/Fax Numbers and E-mail Address);.Technical/Backup Contact (Name, Phone/Fax Numbers and E-mail Address);.Name and Title of person who will sign the website agreement Contract (e.g., CEO,
Executive Director, CIa, etc).
2. Month end eligibility files will be available on the website by5:00 p.m, the day after FAME renewal. MCPs are asked to wait until 5:00 p.m., and the!!, ifyour file is not available, please contact the following EDS staff in the sequence below.(Note: Please allow 30 minutes for a call back before moving on to the next contact):.Monday -Friday 8-5
Team New Technology (Team NT) (916) -919 -6279.Email
Please note that daily files and monthly FAME files are available on the website.
Page 1 of3
MANAGED CARE PLAN/F AME RESPONSffiILITESJanuary 2006
c. Mailing Addresses:
Attn: Chief, Systems Support UnitCA Department of Health SerVices
MMCD/Systems Support Unit1501 Capitol Avenue, Suite 71.4006,MS 4402
PO Box 997413Sacramento, CA 95899-7413
916/449-5244 (FAX)
Attn: (Contract Manager)CA Department of Health Services
MMCD/Plan Management Branch1501 Capitol Avenue, Suite 71.4006, MS 4407
PO Box 997413Sacramento, CA 95859-7413
916/449-5244 (FAX)
Attn: (Contract Manager)CA Department of Health Services
Office of Long TeffilCare1501 Capitol Avenue, Suite 71.6031, MS 0018
PO Box 997413Sacramento, CA 95899-7413
916/322-8619 (FAX)
2, REPORTS/LISTINGS
A, Reports/Listings will be mailed as per the attached schedule (MCP Report Mail Date) via Golden State,unless other arrangements are made, for receipt 3 days after the specified mail date.
3. T~EPICK-UP A@ DISTRIBUTION
Currently, some entities receive tapes with miscellaneous information to assist in claims processing. Also, shouldthe website be unavailable, the Department as a contingency will produce eligibility tapes. The following processmust be followed by MCPs when obtaining tapes in person:
A. Plans must have a designated person(s) on file with the Department before tapes will be Teleased byITSD. Please refer to Section I.A. and C.
B. Tapes will be made available for pick-up after 1 :00 P oM. on the specified date listed on theMEDS/F AME Cut-Off Processing Schedule, under the column labeled 'Misc Tape Mailed bates'. Youmay telephone ITSD in advance to confIrm that your Plan's tape( s) has arrived by calling 916/324-0507
c. Tapes must be picked up by 4:30 p.m. or they win be mailed out by the following workday.
D. Tape problems should be reported to the FAME Processing Technician, Maggie Thomas, at 916/440-7242. The DHS/ITSDhelp desk Phone Nuinber (800/570-0874) can be used for any other problemsrelated to MEDS.
Eo Should the MEDS/FAME Cut-Off Schedule fall on a weekend or holiday, you may contact the MCP orFAME Representative listed below for any questions: (Please allow 30 minutes for a response).
Maggie Thomas, FAME Processing James Pyrah, MCP {MEnS) Processing
MEDS Swing shift
..Phone 916/440-7242
.Phone 916/440-7251
..pager 916/819-2163
F. The tape pick-up is located at:CA Department of Health Services
Information TechIiology Services DivisionData Guidance Unit
1615 Capital Avenue, Second FloorSacramento, CA 95899-7413
Page 2 0.f3
MANAGED CAREPLAN/F AME RESPONSmILITES
4., DHS SECURITY CHECK-IN
A. Please follow the steps below when you visit the Department of Health Services
Notify the Security Guard that a package is to be picked up from the ITSD technician on the 2ndFloor. Ask Security Guard to call Maggie Thomas at 916/440-7242 to have her deliver package tothe lobby.If Maggie isn't available, ask Security Guard to call James Pyrah at 916/440-725.1 to have himdeliver package to the lobby. If James isn't available, call Jennifer Leong, at 916/650-6764 to haveITSD/DGU staff deliver package to the lobby.A Tape Pick-up Log will be given to them to sign. The representative must print and sign theirname and indicate the time of pick-up on the Tape Pick-up Log for their specific plans(s). (NOTE:ITSp will complete the Pick-Up Date, Plan Name/BriefDescription, and the Time the Tape wasMade Available.).All tapes must be returned to ITSD within 30 days from the date of receipt and indicate the person towhom the tapes are to be returned, which is noted on the transmittal. (To eliminate tape fees andunnecessary DHS staff time for monitoring outstanding tapes, it is essential that all tapes be returnedpromptly.)Please return all DHS tapes to:
Attn: (Noted on the Transmittal)CA Department of Health Services
Information Technology Services DivisionHCPIFAMETechP..O. Box 997413
1615 Capital Avenue, 73.272, MS 6303Sacramento, CA 95899-7413
Page 3 of3
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