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Noncapitated Drug Updates for Managed Care PlansDrug listings in the managed care sections of the provider manual are updated as follows.

Dependency Treatment DrugsAlcohol and heroin detoxification and dependency treatment drugs acamprosate calcium (Campral) and naltrexone HCl (Revia) are noncapitated for most managed care plans effective for dates of service on or after June 1, 2006. However, these drugs are capitated for the following plans:

Program of All-Inclusive Care for the Elderly (PACE) Special Project (SP) (Health Care Plans [HCPs] 050 – 056)

Senior Care Action Network (SCAN) SP (HCPs 200 – 201, 204 – 207)

Positive HealthCare Primary Care Case Management (PCCM) (HCP 915)

AIDS DrugsAIDS drug darunavir ethanolate (Prezista) is noncapitated for most managed care plans effective for dates of service on or after June 28, 2006. Efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla) is noncapitated for most managed care plans effective for dates of service on or after July 14, 2006. However, these drugs are capitated for the following plans:

PACE SP (HCPs 050 – 056) SCAN SP (HCPs 200 – 201,

204 – 207) Health Plan of San Mateo

County Organized Health System (COHS) (HCP 503) CalOPTIMA COHS (HCP

506)

Psychiatric DrugsPsychiatric drug selegiline (Emsam) is noncapitated for most managed care plans effective for dates of service on or after April 1, 2006. However, this drug is capitated for the following plans:

PACE SP (HCPs 050 – 056) SCAN SP (HCPs 200 – 201,

204 – 207) Western Health Advantage

Geographic Managed Care (GMC) (HCP 140) Kaiser Health Plan GMC

(HCP 170) Health Plan of San Mateo

COHS (HCP 503) Positive HealthCare PCCM

(HCP 915)

Claims for selegiline that are submitted beyond the six-month billing limit must be submitted hard copy and include a delay reason code. Information about delay reason codes is included in Part 2 claim submission and timeliness sections. A special instruction has been installed in the claims processing system to recognize these claims as timely.

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November 2006

ContentsNoncapitated Drug Updates

for Managed Care Plans............1

Long Term Care Services Clarification................................3

eTAR Submission Guidelinesfor Non-Benefit Services............3

eTAR Training Seminars forMedical and Vision Providers.. . .4

Providers Urged to AvoidUsing Social SecurityNumbers (SSNs)........................4

Prepare To Use NewClaim Forms..............................5

NPI – Will You Be Ready?..............5

NPI Hard Copy andOnline Registration....................5

NPI Local Educational Agency(LEA) Clarification......................7

Electronic Attachments for837 Version 4010A1Claims Now Available................8

RAD Code and CorrelationTable Addition............................8

AEVS Carrier Codes Updates........9

Medi-Cal S&I Provider List..............9

This information is reflected on manual replacement pages mcp cohs 6 and 7 (Part 1), mcp gmc 7 and 8 (Part 1), mcp pre 6 and 7 (Part 1), mcp prim 4 (Part 1) and mcp two plan 6 and 7 (Part 1).

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Border Providers.......................................................................................................................... (916) 636-1200CDHS Medi-Cal Fraud Hotline....................................................................................................1-800-822-6222Telephone Service Center (TSC)...............................................................................................1-800-541-5555Provider Telecommunications Network (PTN).........................................................................1-800-786-4346

EDS PO Box 13029 Sacramento, CA 95813-4029

For a complete listing of specialty programs and hours of operation, please refer to the Medi-Cal Directory in the provider manual.

Opt Out is a service designed to save time and increase Medi-Cal accessibility. A monthly e-mail containing direct Web links to current bulletins, manual page updates, training information, and more is now available. Simply “opt out” of receiving this same information on paper, through standard mail. To download the Opt Out enrollment form or for more information, go to the Medi-Cal Web site at www.medi-cal.ca.gov, and click the “Learn how...” link under OPT OUT on the right side of the home page.

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EDS/MEDI-CAL

Stop Illegal Tobacco SalesThe simplest way to stop illegal tobacco sales to minors is for merchants to check ID and verify the age of

the tobacco purchasers. Report illegal tobacco sales to 1-800-5-ASK-4-ID.

For more information, see the California Department of Health Services Web site at http://www.dhs.ca.gov.

MEDI-CAL FRAUDIS AGAINST THE

LAW

MEDI-CAL FRAUD COSTS TAXPAYERS MILLIONSEACH YEAR AND CAN ENDANGERTHE HEALTH OF CALIFORNIANS.

HELP PROTECT MEDI-CAL AND YOURSELFBY REPORTING YOUR OBSERVATIONS TODAY.

PCDHS MEDI-CAL FRAUD HOTLINE

1-800-822-6222

THE CALL IS FREE AND YOU CAN REMAIN ANONYMOUS.

Knowingly participating in fraudulent activities can result in prosecution and jail time. Help prevent Medi-Cal fraud.

Medi-Cal Update – Program and Eligibility November 2006

Long Term Care Services Clarification“Long Term Care (LTC) services” as it appears in the description of an aid code refers to both those services included in the per diem base rate of the LTC provider and those medically necessary services that are required as part of the patient’s day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).

Providers of these services may submit claims with proper documentation. If applicable, a Treatment Authorization Request (TAR) must be submitted to the appropriate Medi-Cal field office or Pharmacy Office, using existing protocols for core versus regionalized services.

This information is reflected on manual replacement pages aid codes 2, 4, 8 and 12 (Part 1).

eTAR Submission Guidelines for Non-Benefit ServicesAll electronic Treatment Authorization Requests (eTARs) submitted for non-benefit services that do not require a TAR will reject with a message of “TAR not required.” These TARs will not route to a field office for approval and will need to be corrected by the provider as follows:

Click the “Transaction Login” link on the Medi-Cal Web site (www.medi-cal.ca.gov) home page and enter a current Medi-Cal user ID and password. Click “Submit.”

Click the “Online TAR Applications” link.

Select the “Update TAR” function from the TAR menu.

Select “Update Rejected Service.”

In the “Update Patient Information” section, select the special handling code, “Service is a non-benefit and no TAR requirement on procedure file – Review.”

Add one day to the date(s) of service.

– For example, if the “From” date is 05012006 and the “Thru” date is 05012006, change the “Thru” date to 05022006.

Resubmit the TAR request and verify that the status is “In Review.”

To use the eTAR system, providers must have a Medi-Cal Point of Service (POS) Network/Internet Agreement form on file. This form is available on the Medi-Cal Web site (www.medi-cal.ca.gov) by clicking the “Forms” link on the home page.

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eTAR Training Seminars for Medical and Vision ProvidersFirst-time electronic Treatment Authorization Request (eTAR) users and individuals with questions regarding the eTAR submission process are invited to attend one of the free medical and vision care training seminars. These instructor-led seminars are available on a first-come, first-served basis. Participants should arrive an hour prior to the conference start time to allow for parking and onsite registration.

Note: These seminars do not include training for eTAR Pharmacy NCPDP or 18-1 submissions.

Medical and VisionNovember 14, 2006

San Jose Marriott Hotel9:00 a.m. – 11:30 a.m. or1:00 p.m. – 3:30 p.m.301 South Market StreetSan Jose, CA 95113(408) 280-1300

Medical and VisionDecember 12, 2006

Pasadena Hilton Hotel9:00 a.m. – 11:30 a.m. or1:00 p.m. – 3:30 p.m.168 South Los Robles AvenuePasadena, CA 91101(626) 577-1000

Medical and VisionDecember 12, 2006

Ontario Doubletree Hotel9:00 a.m. – 11:30 a.m. or1:00 p.m. – 3:30 p.m.22 North Vineyard AvenueOntario, CA 91764(909) 937-0900

Providers Urged to Avoid Using Social Security Numbers (SSNs)Providers are reminded to use information on a recipient’s Benefits Identification Card (BIC) for verifying eligibility, billing Medi-Cal or submitting Treatment Authorization Requests (TARs) rather than using the recipient’s Social Security Number (SSN).

Beginning in 2007, providers will be required to use a recipient’s 14-character ID number from a BIC or paper card when submitting claims. Claims submitted with a recipient’s SSN will be denied.

ExceptionsCertain exceptions will apply for hospitals, long term care (LTC) facilities, licensed primary care clinics and emergency medical transportation, as indicated by California Welfare and Institutions Code Section 14045. The exception criteria will be based on Place of Service codes.

The excluded entities will be required to make a good faith effort to obtain the recipient’s BIC information for billing and to provide that information to other providers, such as pharmacies and labs, that may not have direct contact with the recipient.

Eligibility Verification Changes ComingProviders also will be required to use the 14-character BIC ID when determining patients’ eligibility verification. A patient’s SSN will no longer be allowed for submitting eligibility verification transactions on the Point of Service (POS) device, Medi-Cal Web site or third-party vendor software.

In an emergency (or if a recipient did not bring a BIC to an appointment), providers will still be allowed to use the SSN for eligibility verification using the telephone Automated Eligibility Verification System (AEVS).

Please see future Medi-Cal Updates for more information.

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Prepare To Use New Claim FormsThe California Department of Health Services (CDHS) is implementing the CMS-1500 and theUB-04 claim forms on March 26, 2007. CDHS will not accept claims billed on these forms prior to this date.

A transition period beginning March 26, 2007 and ending on close of business May 22, 2007 will allow providers to bill using either the HCFA 1500 claim form and the UB-92 Claim Form or the new CMS-1500 and UB-04 claim forms. Effective May 23, 2007, providers must bill using the CMS-1500 and UB-04 claim forms and entering the National Provider Identifier (NPI) instead of the Medi-Cal provider number.

Important: When billing on the new forms prior to May 23, 2007, the Medi-Cal providernumber must be used instead of the NPI. Implementation of the NPI takes placeon May 23, 2007.

NPI – Will You Be Ready?Get It.The compliance date, May 23, 2007, is now only six months away. It’s every provider’s responsibility to obtain a National Provider Identifier (NPI) if required to do so. If you’re not sure if you need one, it’s time to investigate. Get your NPI now so you have time to prepare before the compliance date. This includes sharing your NPI with Medi-Cal. You must register your NPI with Medi-Cal in order to avoid a disruption in your cash flow. To learn more about how to apply, visit the NPI area of the Medi-Cal Web site (www.medi-cal.ca.gov) and the Centers for Medicare & Medicaid Services (CMS) Web site at www.cms.hhs.gov/NationalProvIdentStand / .

Share It.Have your NPI and don’t know what to do with it? Share it with health plans you bill and the colleagues who need your NPI to submit their claims (for example, those who bill for ordered or referred services). You should also share it with your billing service, vendor or clearinghouse business associates. Find out when and how the health plans with which you do business will begin accepting the NPI in claims and other standard transactions.

Getting an NPI is free – not having one can be costly.

NPI Hard Copy and Online Registration HIPAA mandates the use of National Provider Identifiers (NPIs) by providers beginningMay 23, 2007. The California Department of Health Services (CDHS) encourages providers to apply for their NPI at the National Plan and Provider Enumeration System (NPPES) Web site (https://nppes.cms.hhs.gov) then register their NPI with Medi-Cal. Early NPI registration with Medi-Cal will assist providers in maintaining uninterrupted claim payments as Medi-Cal transitions from the current provider numbering system to the HIPAA-mandated NPI system.

Medi-Cal and Child Health and Disability Prevention (CHDP) providers are encouraged to use the online Web application to register their NPIs more quickly, accurately and cost-free. The online NPI registration tool became available on the Medi-Cal Web site on September 1, 2006 and may be accessed by clicking the “NPI” link on the Medi-Cal Web site (www.medi-cal.ca.gov), then the “Register/Update/Inquire NPIs” link in the “NPI Resources” area.

Please see NPI, page 6

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NPI (continued)

The registration allows Medi-Cal and CHDP providers to register one NPI for each activeMedi-Cal/CHDP provider number. If a provider has both a Medi-Cal and CHDP provider number, the NPI will be automatically updated for both programs when a Medi-Cal/CHDP provider registers their NPI with Medi-Cal by using either the online NPI collection tool or the registration form.

NPIs registered with Medicare, and taxonomy codes provided in the original NPI application to NPPES, will also be collected on the registration form. NPIs for Non-Physician Medical Practitioners (NMPs) will be collected for providers who currently have NMP data on file with Medi-Cal.

The registration includes a list of agreement forms that contain the current Medi-Cal provider number. Providers can authorize the update of existing agreements on file with their NPI information by indicating the action on the registration form.

Providers With More Than One Active Medi-Cal or CHDP NumberProviders who have more than one active Medi-Cal or CHDP provider number must complete a separate registration for each existing provider number to register a single or subpart NPI. Providers may register only one NPI per provider number.

In most cases, the provider may choose to register either the same NPI or the subpart NPI to replace multiple provider numbers.

Pursuant to Code of Federal Regulations, Title 42, Section 424.57, providers of Durable Medical Equipment (DME), prosthetics, orthotics and medical supplies are required to use a separate NPI for each individual business location, in accordance with the HIPAA-NPI final rule. Medi-Cal providers subject to this provision of the final rule have yet to be determined. CDHS encourages providers to refer to future Medi-Cal Updates, or to the NPI Overview page, for a final determination on Medi-Cal requirements for this rule.

Separate “Pay-to” and “Mail-to” Addresses, Differing EFT Accounts and PINsMedi-Cal allows providers to use separate “Pay-to” and “Mail-to” addresses, as well as differing Electronic Funds Transfer (EFT) account information and Personal Identification Numbers (PINs) for each provider number. Medi-Cal policy regarding such addresses and accounts will continue for each NPI registered.

Providers who choose to replace multiple Medi-Cal and CHDP provider numbers with one NPI must designate which Medi-Cal provider number will be the source of the various addresses, accounts and PINs that will be associated with the new NPI number. If a primary Medi-Cal or CHDP provider number is not specified for the new NPI, then the first Medi-Cal provider number on file will be replaced with the new NPI, by default, and be used to determine which addresses, accounts and PINs will be associated with that NPI.

Note: For Medi-Cal and CHDP organizational providers wishing to maintain multiple “Pay-to” or “Mail-to” addresses, differing EFT accounts, or PINs consistent with the number of Medi-Cal and CHDP numbers and locations currently enrolled, CDHS encourages the use of unique NPIs for subparts.

Please see NPI, page 7

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NPI (continued)

Registering Multiple NPIs for Multiple Medi-Cal and CHDP Provider NumbersThe NPI registration form does not allow registration of more NPIs than existing Medi-Cal/CHDP provider numbers. CDHS is reviewing the NPI final rule requirements relative to accepting multiple NPIs in excess of the existing provider numbers. If your organization has more subpart NPIs than existing Medi-Cal or CHDP provider numbers, CDHS encourages you to refer to future Medi-Cal Updates or the NPI Registration page for a final determination on Medi-Cal requirements for thisNPI rule.

Providers Not Required to RegisterIn accordance with the NPI final rule, some providers are not required to register an NPI withMedi-Cal. According to CDHS’ interpretation of the final rule, as it relates to “atypical” providers, the following Medi-Cal provider types are not required to register an NPI:

Adult Day Health Care Centers

Blood Banks

Christian Science Practitioners

Multipurpose Senior Services Programs

Beginning in November 2006, Medi-Cal and CHDP providers may also register their NPI with CDHS using the hard copy NPI registration form. The NPI registration form will be available on theMedi-Cal Web site (www.medi-cal.ca.gov) by clicking “Forms,” then “Provider Enrollment.” Forms can also be obtained by calling the Telephone Service Center (TSC) at 1-800-541-5555 and selecting option 16, followed by option 18.

If the hard copy NPI registration form is used, the NPPES NPI assignment letter must be attached to the completed form. The return address for the form and NPPES letter is printed on the registration form.

NPI Local Educational Agency (LEA) ClarificationAfter further review of the National Provider Identifier (NPI) final rule and the industry definition of “atypical” providers, the California Department of Health Services (CDHS) has determined that Local Educational Agency (LEA) providers participating in Medi-Cal do not meet the criteria to be “atypical” providers. Therefore, LEA providers are required to apply for an NPI.

LEA providers should apply for an NPI on the National Plan and Provider Enumeration System (NPPES) Web site at https://nppes.cms.hhs.gov. Upon receipt of an NPI, LEA providers are required to register their NPI with Medi-Cal through the National Provider Identifier Collection (NPIC) online system. To access the NPIC online system, click the “NPI” link on the Medi-Cal Web site (www.medi-cal.ca.gov) home page and then click “Register, Update and Inquire About NPIs.”

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Electronic Attachments for 837 Version 4010A1 Claims Now Available In addition to paper and fax attachments, providers now have the ability to submit attachments electronically with their 837 Version 4010A1 electronic claim submissions through an approved third-party vendor. The following guidelines should be used for submitting electronic attachments:

ProvidersTo submit electronic attachments, providers must be authorized to bill 837 v.4010A1 electronic claims and enter into a business agreement with a third-party vendor that offers the ability to enter an Attachment Control Number (ACN) in the Paperwork (PWK) Segment of the 837 v.4010A1 electronic transactions. For a list of approved third-party vendors, providers may refer to the CMC Developers, Vendors and Billing Services Directory, available on the “Technical Publications” page of the Medi-Cal Web site (www.medi-cal.ca.gov). To access the page, click “Technical Specs” under the “Provider Resources” area of the home page.

The approved third-party vendor will preprocess the attachments and send the images electronically to Medi-Cal on the provider’s behalf. Medi-Cal then links the electronic attachments to the corresponding electronic claim. The vendor preprocessing the claim attachment will supply the provider with the ACN for the electronic transaction.

Providers have a maximum of 30 calendar days from the claim submission date to include the supporting electronic attachments. For further information regarding attachment submissions, please refer to the Billing Instructions section of the 837 Version 4010A1 Health Care Claim Companion Guide available on the Medi-Cal Web site. To access the guide, click “HIPAA” on the home page, then “ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications.”

VendorsVendors interested in providing electronic attachment processing services must be true “vendors” or “service providers,” which means they offer their services to the general public. Please review the Medi-Cal Electronic Attachment and Image Specifications (Third-Party Vendors) for details about transmitting electronic attachment images to Medi-Cal. The specifications document is available on the “ASC X12N Version 4010A1 Companion Guides and NCPDP Technical Specifications” page on the Medi-Cal Web site. Vendors who have reviewed the specifications and are ready to enter into a business agreement with EDS should call the Telephone Service Center (TSC) at 1-800-541-5555 (select option 16, then 11) to obtain a business agreement.

RAD Code and Correlation Table AdditionThe following Remittance Advice Details (RAD) message has been added to help reconcile provider accounts.

AdditionCode Message

9875 Inserts are reimbursable only with diabetic shoes.

Also, Adjustment Reason Codes (ARC), Adjustment Group Codes (AGC), Health Care Remarks Codes (HCRC) and description updates have been added to the Remittance Advice Details (RAD) Electronic Correlation Table to National Codes sections in the Part 1 manual.

This information is reflected on manual replacement pages remit cd9000 43 (Part 1),remit elect corr9800 3 (Part 1) and remit elect corr hcrc 3 (Part 1).

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AEVS: Carrier Codes for Other Health Coverage: November UpdateThe AEVS: Carrier Codes for Other Health Coverage list has been updated. These codes are

updated monthly. For a complete AEVS: Carrier Codes for Other Health Coverage list, visit the Medi-Cal Web site at www.medi-cal.ca.gov. Click the “User Guides” link under “Provider Resources,” then click the “AEVS User Guide” link. Additions and changes are shown in bold and underlined type.

Providers may order a hard copy update of the section by calling the Telephone Service Center (TSC) at 1-800-541-5555. Updates are listed below.

Code Carrier Code Carrier

A508 CENTRAL PARKING SYSTEMS P288 PINNACLE CLAIMS MANAGEMENT INCA798 ARTA WESTERN NETWORK W128 WESTERN TEAMSTERS WELFAREC141 BENEFIT COORDINATORS INC W140 FISERV HEALTH

Medi-Cal Suspended and Ineligible Provider List: November UpdateThe Medi-Cal Suspended and Ineligible Provider List (S&I List) has been updated. This list is

updated monthly. For a complete S&I List, visit the Medi-Cal Web site at www.medi-cal.ca.gov and click the “S & I Provider List” link under “Provider Reference.” Providers may also order a hard copy update of the section by calling the Telephone Service Center (TSC) at 1-800-541-5555.

Additions and changes are shown in bold type and reinstated providers are removed from the S&I List. Always refer to the S&I List when verifying provider ineligibility.

Osteopath (susp A)

Allen, Daniel M. 20A6486 Suspended426 Neal Street indefinitely effectiveGrass Valley, California 9/20/2006.

Awad, Aziz F., D.O. 20A6241 SuspendedActive Care Medical Group indefinitely effective606 South Euclid Street 3/7/2006.Anaheim, California and9436 Slauson AvenuePico Rivera, California

Daly, James Edmond 20A5105 Suspended17629 Vierra Canyon Road indefinitely effectiveSalinas, California 2/24/2006.

Nguyen, Michael M. Suspended1069 Nicklaus Avenue indefinitely effectiveMilpitas, California 9/20/2006.

Physician (susp A)

Blanchard, Phillip Briar G51137 SuspendedP.O. Box 15065 indefinitely effectiveLong Beach, California 1/24/2006. and2089 Vale Road, Suite #23San Pablo, California

Boyce, Daniel J. A23178 Suspended1514 North Sycamore Street indefinitely effectiveSanta Ana, California 3/2/2006. and805 West La Veta Avenue,Suite #104Orange, California

Physician (susp A)

Duran, Paul Joseph A60506 Suspended11645 Wilshire Boulevard, indefinitely effectiveSuite #1070 7/29/2005.Los Angeles, California and1328 22nd StreetSanta Monica, California

Eckstein, Larry G29690 Suspended2760 29th Street, Suite #2D indefinitely effectiveBoulder, Colorado 6/16/2006. and1437 7th Street, Suite #301Santa Monica, California

Jackson, D. Anthony G33174 Suspended aka: Jackson, Anthony indefinitely effective19004 Ivanpah Way 9/22/2005.Apple Valley, California and18300 Gridley Road,Suite #301Artesia, California

Jackson, George F. G9779 Suspended372 Arden Avenue, Suite #102 indefinitely effectiveGlendale, California 8/19/2005. and2231 South Western AvenueLos Angeles, California and2300 South Hope Street,Suite #500ALos Angeles, California

Please see S&I, page 10

10


S&I (continued)

Physician (susp A)

Johnson, John L. A12856 Suspended300 South Beach Boulevard indefinitely effectiveLa Habra, California 6/15/2005. and6725 Seville AvenueHuntington Park, California and2680 Saturn Avenue,Suite #200Huntington Park, California and504 South Sierra Madre BoulevardPasadena, California

Karpman, Beverly A. G37677 Suspended2021 Santa Monica Boulevard, indefinitely effectiveSuite #500E 1/4/2006.Santa Monica, California

Kerwood, Robert I. A29042 Suspended64 Grand Avenue indefinitely effectiveOroville, California 6/23/2005. and3 Court StreetWoodland, California

Khan, M. Ibrahim C41598 Suspended10540 Wilshire Boulevard indefinitely effectiveLos Angeles, California 9/15/2005. and4455 West 117th StreetHawthorne, California

Khatibloo, Matthew Saeed A39389 Suspended11100 Warner Avenue, #218 indefinitely effectiveFountain Valley, California 6/30/2006. and951 South Beach BoulevardLa Habra, California

Levy, Jonathan Sandler G86671 Suspended1717 Centennial Boulevard, indefinitely effectiveSuite #6 10/14/2004.Springfield, Oregon and1110 18th StreetSpringfield, Oregon

Manzur, Juan Esber G59934 Suspended1621 East Sahara Avenue indefinitely effectiveLas Vegas, Nevada 7/11/2005.

McGuire, Joseph Smith G69563 Suspended106 Peter Coutts indefinitely effectiveStanford, California 12/10/2004. and1350 Willow Road,Suite #202Menlo Park, California

Physician (susp A)

Moon, Chae Hyun A32120 Suspended15821 Texas Spring Road indefinitely effectiveRedding, California 9/20/2006. and1555 East Street, Suite #100Redding, California and1450 Liberty StreetRedding, California

Organ, Paul Gerard A39998 Suspended3144 Broadway, Suite #246 indefinitely effectiveEureka, California 5/5/2006. and10850 MacArthur Boulevard,Suite #201Oakland, California

Rodas, Jesus M. C15619 Suspended3004 Whittier Boulevard indefinitely effectiveLos Angeles, California 10/25/2006. and2026 East 1st StreetLos Angeles, California

Psychiatric Technician (susp C)

Church, Jeane Lynn 30488 Suspended aka: Coggeshall, Jeane Lynn indefinitely effective Cale, Jeane Lynn 1/1/2006.P.O. Box 478Atascadero, California

Henderson, Jon Timothy 28197 Suspended10336 Loch Lomond Road, indefinitely effectiveSuite #430 9/11/2005.Middletown, California

Jose, Fortunato I. PT26102 Suspended aka: Fortunato, Jose indefinitely effective Jose, Tito 6/5/2005.600 Echo Summit RoadVallejo, California

Keane, Peter Canisius PT29463 Suspended8262 Atlanta, Apartment #29 indefinitely effectiveHuntington Beach, California 7/15/2005.

Latham, Jospeh Paul PT24421 Suspended450 West Foothill, indefinitely effectiveApartment #18 7/29/2005.Pomona, California

Mansergh, Daniel Adrian 31573 Suspended1672 Irwin Street indefinitely effectiveTulare, California 9/17/2005.

Morales, Karen Lee 19253 Suspended4205 Evert, Apartment #B indefinitely effectiveMontclaire, California 10/23/2006.

Timungwa, Valerie Manka 154571 Suspended aka: Timungwa, Valerie indefinitely effective Nkenwi 10/23/2006.3701 West 112 Street, #2Inglewood, California


11

S&I (continued)

Psychologist (susp C)

Fields, Preston Brian Suspended19126 Olympic Crest Drive indefinitely effectiveCanyon Country, California 9/20/2006. and15720 Ventura Boulevard,Suite #503Encino, California and18546 Roscoe Boulevard,Suite #210Northridge, California

Dental Assistant (susp G)

Gonzalez, Shirley Dean 54104 SuspendedP.O. Box 2763 indefinitely effectiveCarmichael, California 3/1/2005.

Orozco, Melissa Christine 58061 Suspended81-592 Santa Clara Court indefinitely effectiveIndio, California 9/20/2006.

Dentist (susp G)

Abusbitan, Abdulkadir Yousef 41576 Suspended48 Park Plaza Drive, Suite #263 indefinitely effectiveDaly City, California 3/1/2005.

Berthelsen, Roger Lee 31895 Suspended180 East Palm Canyon Drive indefinitely effectivePalm Springs, California 4/10/2005.

Flanagan, Hatti M. 13585 Suspended aka: Foley, Hatti M. indefinitely effective Flanagan, Hatti Maelynne 6/5/2005.7985 Santa Monica Boulevard,Suite #109West Los Angeles, California

Guerra, Kimberly Lynn 50363 Suspended2621 Sheri Lane indefinitely effectiveLemon Grove, California 4/10/2005.

Lavi, Jacob Jonathan 38074 Suspended17200 Ventura Boulevard, indefinitely effectiveSuite #309 10/25/2006.Encino, California

Mansueto, Robert 25941 Suspended1301 Ynez Place indefinitely effectiveCoronado, California 6/5/2005.

Mayers, Ann Louise 31073 Suspended4110 Moorpark Avenue, indefinitely effectiveSuite #B 4/10/2005.San Jose, California and5480 Makati CircleSan Jose, California

Mesbah, Rahim 48961 Suspended4108 Mercer Drive indefinitely effectiveModesto, California 10/25/2006.

Vrenon, Paul Eric 44797 Suspended8650 West Spring Mountain indefinitely effective Road, #101 3/1/2005.Las Vegas, Nevada

Acupuncturist (susp I)

Grigoryan, Gratch A74850 Suspended aka: Grigoryan, Grach indefinitely effective1726 Winona Boulevard, #202 10/26/2006.Los Angeles, California

Lee, Ha Kil AC-8135 Suspended1027 South Mansfield Avenue indefinitely effectiveLos Angeles, California 9/20/2006.

Chiropractor (susp J)

Bahnsen, John Joseph, D.C. 22277 SuspendedP.O. Box 207 indefinitely effectiveSanta Barbara, California 10/26/2006.

Fitches, Spencer 21685 Suspended17000 Clark Avenue indefinitely effectiveBellflower, California 10/20/2005.

Garsha, Marlena R., D.C. 24884 Suspended2211 Martin Street, indefinitely effectiveSuite #113 10/26/2006.Irvine, California

Holl, Patricia 25705 Suspended6801 Coldwater Creek Canyon indefinitely effective Avenue, Suite #1C 9/26/2005.North Hollywood, California

Paik, Kenneth II Whan 22557 Suspended3944 Grandview Drive indefinitely effectiveBrea, California 9/26/2005.

Pavlov, Andrey A. 25607 Suspended14471 Clarissa Lane indefinitely effectiveTustin, California 12/28/2005.

Starrett, Scott Douglas DC Suspended167 Flying Cloud Isle 18654 indefinitely effectiveFoster City, California 8/8/2005.

Podiatrist (susp K)

Heard, Geoffrey S. E3700 Suspended1256 Alameda Drive indefinitely effective De Las Pulgas 9/20/2006.Redwood City, California

Home Health Aide (susp P)

Harris, Preston CNA Suspended599 Groth Drive 575371 indefinitely effectiveSan Jose, California 4/6/2004.

Head-Pele, Irene Suspended3202 Duke Street indefinitely effectiveSan Diego, California 10/31/2006.

Prentiss, Allena HHA Suspended7446 Flores Way 174187 indefinitely effectiveSacramento, California 6/26/2006.

Towels, David S. HHA Suspended320 Goya Drive 38201 indefinitely effectiveStockton, California 8/15/2006.


S&I (continued)

Optometrist (susp Q)

Washburn, Paul Lawton 4608 SuspendedP.O. Box 204 indefinitely effectivePlacerville, California 9/24/2006.

Certified Nurse Assistant (susp R)

Abon, Rodolfo CNA Suspended4622 La Vante Street 561314 indefinitely effectiveLong Beach, California 6/30/2006.

Aragon, Tami CNA Suspended1225 West Oakland Avenue 628162 indefinitely effectiveTulare, California 7/11/2006.

Bacus, Ronald CNA Suspended240 South Midway 601375 indefinitely effectiveEscondido, California 6/14/2006.

Boteo Aura CNA Suspended620 Grand Avenue, 59049 indefinitely effectiveApartment #1 4/24/2006.South San Francisco, California

Bulosan, Junard CNA Suspended335 Chesterfield Avenue 603044 indefinitely effectiveHalf Moon Bay, California 5/25/2006.

Buttery, Connie Mae 549812 Suspended2421 Monte Vista Avenue indefinitely effectiveOroville, California 8/9/2006.

Carpenter, Izetta CNA Suspended12223 Jehant Road 473429 indefinitely effectiveAcampo, California 5/4/2006.

Flores, Maria CNA Suspended134 North Mariposa Avenue, 257171 indefinitely effective#304 5/18/2006.Los Angeles, California

Ghuman, Surinder CNA Suspended3646 Santa Cruz Court 442333 indefinitely effectiveHemet, California 5/15/2006.

Harris, Preston CNA Suspended599 Groth Drive 575371 indefinitely effectiveSan Jose, California 4/6/2004.

Head-Pele, Irene CNA Suspended3202 Duke Street 358682 indefinitely effectiveSan Diego, California 10/31/2006.

Honeycutt, Danielle CNA Suspended2200 Coffee Road, #43 595033 indefinitely effectiveModesto, California 7/10/2006.

Joaquin, Ricardo CNA Suspended3245 Hugo Street 411227 indefinitely effectiveSan Diego, California 5/19/2006.

Juddine, Treshunda CNA Suspended6603 Brynhurst Avenue, 573270 indefinitely effectiveApartment #107 5/15/2006.Los Angeles, California


Lopez, Imelda CNA Suspended2328 East Jewett Street 441926 indefinitely effectiveSan Diego, California 7/27/2006.

Maharaj, Sunita CNA Suspended aka: Sandy 561427 indefinitely effective9737 Hawkins Court 8/22/2005.Elk Grove, California

Millora, Charisma CNA Suspended55 Valle Vista, #616 461774 indefinitely effectiveVallejo, California 10/1/2004.

Moore, Holly CNA Suspended6165 Pony Express Trail, #38 659913 indefinitely effectivePollock Pines, California 2/10/2005.

Morales, Hector CNA Suspended4050 Stevely Avenue, #5 219980 indefinitely effectiveLos Angeles, California 3/17/2005.

Pangilinan, Rochelle CNA Suspended675 Templeton Avenue 603048 indefinitely effectiveDaly City, California 6/22/2006.

Paredes, Jose J. CNA Suspended6928 Amigo Avenue 473825 indefinitely effectiveReseda, California 5/11/2006.

Prentiss, Allena CNA Suspended7446 Flores Way 569026 indefinitely effectiveSacramento, California 6/26/2006.

Rodriguez, Edgardo CNA Suspended23450 San Fernando Road, 597819 indefinitely effectiveUnit #146 5/8/2006.Newhall, California

Rodriguez, Maria CNA Suspended412 1/2 San Angelo 472916 indefinitely effectiveLa Puente, California 6/16/2006.

Seldon, Pelma CNA Suspended5261 El Dorado Avenue, #10 510208 indefinitely effectiveEl Cerrito, California 5/13/2004.

Starr, Tina Marie CNA Suspended5709 Rosario Boulevard, 578156 indefinitely effectiveApartment #2 7/24/2006.North Highlands, California

Towels, David S. CNA Suspended320 Goya Drive 158313 indefinitely effectiveStockton, California 8/15/2006.

Turner, Marcus J. CNA Suspended2140 Mentone Boulevard, #160 431675 indefinitely effectiveMentone, California 8/3/2006.

Wharton, Deborah CNA Suspended12422 Amber Street 547337 indefinitely effectiveGrass Valley, California 2/10/2005.


S&I (continued)

Licensed Vocational Nurse (susp R)

Caruthers, Christopher Ameil 189193 Suspended aka: Caruthers, Christopher indefinitely effective Amile 10/18/2001.1271 Barstow RoadBarstow, California

Christensen, Christopher Ward 77494 Suspended1426 7th Street indefinitely effectiveLos Osos, California 9/1/2005.

Farrell, Annie Laura 51740 Suspended807 Thomas Street indefinitely effectiveUnion Springs, Alabama 9/20/2006.

Gamazon, Elena Frial 128102 Suspended5214 1/2 Melrose Avenue indefinitely effectiveLos Angeles, California 7/29/2005.

Gutierrez, Juan C. 197563 Suspended aka: Gutierrez, Juan Carlos indefinitely effective523 West 2nd Street 7/28/2005.San Pedro, California

Kowalski-Hall, Dianne VN Suspended aka: Pearson, Diane Kowalski 96396 indefinitely effective Kowalski, Diane 7/10/2005.8505 Marchant AvenueAtascadero, California

Lee, Evelyn Yvonne VN Suspended1423 Manzana Way 188570 indefinitely effectiveSan Diego, California 7/15/2005.

McCain, Pairlee VN34524 Suspended aka: McCain, Pat indefinitely effective Robinson, Pairlee 7/17/2005.2703 Adee LaneBakersfield, California

Odumosu, Yvette Elena VN Suspended aka: Hamilton, Yvette Elena 170371 indefinitely effective Hamilton, Lisa Michelle 10/17/2006.1415 North Chester AvenueCompton, California

Osborne, Deborah Louise 135409 Suspended1524 South Avenue indefinitely effectiveGustine, California 12/9/2005.

Parsons, Arden Marie 195279 Suspended535 East Yanonali Street indefinitely effectiveSanta Barbara, California 7/28/2005.

Plunkett, Kenneth Charles 184575 Suspended2411 Taffrail Lane indefinitely effectiveOxnard, California 7/23/2005.

Simpson, Jennifer Mary 194638 Suspended aka: Knapp, Jennifer Mary indefinitely effective6176 West Indian Oak Drive 9/22/2005.West Jordan, Utah

Vestal, Rebecca Helen 33729 SuspendedP.O. Box 2644 indefinitely effectiveFairfield, California 9/23/2005.

Nurse Aide (susp R)

Friedman, Victor Lewis NA00 SuspendedLongview Work Release 137243 indefinitely effective1821 First Avenue 9/20/2006.Longview, Washington

Public Health Nurse (susp R)

Walling, Mary Jo Anne 32447 Suspended aka: McConnelly, Jo Ann indefinitely effective1817 Taft Avenue, 9/22/2005.Apartment #3Los Angeles, California

Registered Nurse (susp R)

Bathurst, David John 461892 Suspended13920 Kiowa Road indefinitely effectiveApple Valley, California 9/20/2006.

Fernandez, Julie Marie RN Suspended8446 East Chaparral Road 475489 indefinitely effectiveScottsdale, Arizona 9/20/2006.

Filomeo, Catherine Ann 390732 Suspended aka: Ugalde, Catherine Ann indefinitely effective Lalancette, Catherine Ann 9/30/2005. Ree, Catherine AnnP.O. Box 472Alturas, California

Gish, Aerika Kohara Frye 556204 Suspended aka: Gish, Aerika indefinitely effective Frye, Aerika 9/20/2006. Kohara, Aerika144 Hollywood AvenueOxnard, California

Walling, Mary Jo Anne 334034 Suspended aka: McConnelly, Jo Ann indefinitely effective1817 Taft Avenue, 9/22/2005.Apartment #3Los Angeles, California

Respiratory Care Practitioner (susp S)

Badescu, Smaranda Angela 8656 Suspended11914 King Street, indefinitely effectiveApartment #15 9/27/2005.North Hollywood, California

Bento, Michael G. 6523 Suspended7412 Cuvier Street, indefinitely effectiveApartment #8 9/21/2005.La Jolla, California

Stupin, Elizabeth 6153 Suspended18833 Carreta Drive indefinitely effectiveRowland Heights, California 9/21/2005.


S&I (continued)

Business Owner (susp T)

Hart, Rose V. Suspended14520 Dickens, indefinitely effectiveApartment #111 9/20/2006.Sherman Oaks, California

Pakdelan, Mohammad Suspended6509 Verde Ridge Road indefinitely effectiveVerded, California 9/20/2006. and7004 Reseda BlvdReseda, California

Shandize, Michael I. Suspended15322 Longbow Drive indefinitely effectiveSherman Oaks, California 9/20/2006.

Employee (susp T)

Augur, Carol Leann Suspended43800 Wilson Valley Road indefinitely effectiveHemet, California 10/24/2006.

Morales, Mary Magdalene Suspended2017 North Dern Avenue indefinitely effectiveLos Angeles, California 10/17/2006.

Saguin, Khalila Cruz Suspended11901 East 176th Street indefinitely effectiveArtesia, California 10/17/2006.

In-Home Support Services Provider (susp U)

Condra, Bernice Suspended aka: Fusilier, Bernice indefinitely effective937 Drake Avenue 9/20/2006.Marin, California

Ludan, Delia Correa Suspended aka: Correa, Delia Abenes indefinitely effective820 Lomita Avenue 9/20/2006.Millbrae, California

Vasquez, Francisca Magdalena Suspended aka: Vasquez, Magdalena indefinitely effective14 Manchester Court 9/20/2006.Novato, California

REINSTATEMENTS:

Physician (susp A)

Kamson, Adetokunbo A43596 9/1/2006P.O. Box 1102Manhattan Beach, California

Windgrove, Daniel D., M.D. A411520 10/18/2006101 North La Brea Avenue, A411521Suite #606 A411522Inglewood, California A411523 and1350 Chestnut AvenueLong Beach, California and1704 West Manchester AvenueLos Angeles, California and14738 Crenshaw BoulevardGardena, California


Martinez, Maria 00328920 4/20/2006831 East 109th PlaceLos Angeles, California

Employee (susp T)

Lennartz, Thomas 19516 9/18/200611276 Washington BoulevardCulver City, California

Instructions for Manual Replacement Pages Part 1November 2006

Remove: aid codes 1 thru 13Insert: aid codes 1 thru 15

Remove and replace: mcp cohs 5 thru 7mcp gmc 7/8mcp pre 5 thru 7mcp prim 3/4mcp two plan 5 thru 7other 5/6 *remit cd9000 43remit elect corr9800 3remit elect corr hcrc 3tar 1/2 *

The following updated sections are available at www.medi-cal.ca.gov:

AEVS: Carrier Codes for Other Health Coverage

Medi-Cal Suspended and Ineligible Provider List

* Pages updated due to ongoing provider manual revisions.

part 1 - californiafilesaccepttest.medi-cal.ca.gov/.../part1/archive/word/pa… · web viewstarr,...

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