Managed by MedPoint Management
September 1999 Edition

 

 
PROVIDERS HAVE RIGHTS!!

Participating Providers have the right to request a review of the information obtained from primary sources during the credentialing process (e.g. malpractice carriers, state licensing boards, National Practitioner Data Bank). If you suspect any erroneous information is contained in your credentialing file and you would like to request a review, please contact Ann McMunn, Credentialing Supervisor, at 818 702-0100, extension 247 for details. As always, it is MedPOINT Management's standard to immediately inform participating providers should information received in the credentialing process vary substantially from the information supplied by the provider

MedPOINT Management's credentialing files will at all times be treated with sensitivity and confidentiality. Provider credentialing information is protected as defined by Section 1157 of the California Evidence Code.

 


MedPOINT MANAGEMENT IS HERE TO HELP!

Please inform us of your scheduled Facility Site Review with L.A. Care. As you know, one of the criteria for maintaining your status as a participating provider with contracted health plans is a satisfactory score in both medical records and facility operation. If you participate in the Medi-Cal Managed Care Program, this includes criteria considered Critical by LA Care Health Plan and its Plan Partners. Overall scores <80% or a Critical Criteria score <90% on a L.A. Care Health Plan Facility Site Review will effectively close your practice site to new enrollment until you have successfully completed the Corrective Action Plan as outlined by LA Care's description of deficiencies. Please contact the Quality Improvement Department when you receive notice of LA Care Facility Site Review. Should you need assistance in preparing prior to the LA Care visit or in the implementation of a Corrective Action Plan, we can schedule a time for a Quality Improvement Specialist to make a visit to your practice site. The Quality Improvement Department can be reached at 818 702-0100, extension 231 or 247.

 

Please submit your PM 160 forms and encounters timely. The state timeliness requirement is now in effect and must be followed.

 

  

PM 160 INF QUICK TIPS

As you probably know by now, these is a state timeliness requirement for PM 160 INF forms. The PM 160 forms are due to the health plans by the 10th day of each month for the previous month's CHDP services.This means that MedPOINT must receive the completed forms by the 3rd of each month. Please note: Health Net has pre printed forms that can be submitted directly to them and they do not need to be routed to MedPOINT. Supplies of these forms will be sent to your office soon so the process can be expedited. There are a few quick tips to follow when filling out the forms:

  • Fill out every PM 160 form completely.
  • Every PM 160 form must be signed.
  • Only the correct Health Plan Code (HPC) should appear in the Prepaid Project Code box. The HPC is 3 digits. If you do not know the correct HPC number, contact your CHDP coordinator.
  • An ICD-9 code must be entered in the ICD-9 box even if no illnesses are presented. For example, a V202 code for a "routine or child health check" may be appropriate.
     

Global Care
Quality Advisor