NOTICE FOR PRIOR-AUTHORIZATION REQUESTS For all Contracted Providers, CHCN will no longer require a prior authorization (PA) for Obstetrics (OB) and related Genetic testing. Please see the comprehensive list here.
Please sign up for Electronic Funds Transfer (EFT)
CHCN is working towards innovation and improving our payment delivery system. As we shift from mailed paper checks to direct deposit, we are asking all provider groups to sign up for Electronic Funds Transfer (EFT) by January 1, 2021.
Statement on Authorization Extensions during COVID 19 Pandemic: During this unprecedented time of Pandemic, including the “Stay at Home” order in place for Alameda County residents, Community Health Center Network is looking for ways to reduce barriers to our members receiving the care that they need. During this time, much non-urgent care that members need is being delayed if it cannot be provided using a telehealth modality. For this reason, we will be extending all authorizations for service from March 17th (the date that Alameda County first implemented “Stay at Home”) and will continue until we have moved back to a more normal care delivery scenario. These authorizations will have an expiration date extended to six months following the authorization date. This extension will make it easier for members and providers to resume care as soon as it is safe. These authorizations will still have the units of service amount reflected in the authorization so additional services beyond this number will require reauthorization. As always, care should be provided in a medically necessary and clinically appropriate fashion.
Radiology Billing Requirements: Effective June 1, 2019, providers will be required to identify professional and technical component using appropriate modifiers (“26” or “TC”) on radiology services. Radiology services include but are not limited to procedure codes ranging from 70000 through 79999. CHCN requires this information in order to process claims in accordance with contracted health plans’ Division of Financial Responsibility (DOFR). After June 1 2019, radiology procedures billed without a modifier will be adjusted “UDM9” instructing providers to bill with the appropriate modifier.
Also effective June 1, 2019, Alameda Alliance for Health is the appropriate payor for technical component of radiology services in all places of service (POS), including office setting (POS 11). After June 1, 2019, technical component of radiology procedures will be adjusted “UDB7” and providers will be instructed to bill the health plan. CHCN will forward claims received with technical component to the health plan. CHCN will continue to process technical component for radiology procedures for CHCN Anthem Blue Cross members in a place of service 11.
For exact CPT codes reference the Medi-Cal table at: https://files.medi-cal.ca.gov/Rates/rates_range_display.aspx.
Beginning April 1, 2019, Anthem Blue Cross will perform inpatient utilization reviews for hospitalized CHCN Anthem members. Please submit your request directly to Anthem Blue Cross at Fax: (866) 333-4826. To ensure your request has been processed, please contact Anthem Blue Cross at Phone: (888) 831-2246 option #3.
Authorization requests for outpatient services for CHCN Anthem members remain unchanged.
Requests for CHCN Alameda Alliance for Health (AAH) also remain unchanged.
CHCN will continue to process inpatient and prior authorization requests for CHCN AAH members.
CHCN has ‘Saturday’ nurse coverage to meet your Inpatient and Outpatient Utilization Management needs.
For assistance with Inpatient authorizations call (510) 314-4388. For assistance with Outpatient authorization call (510) 754-8873.
Please contact CHCN Customer Care at 510-297-0242 or firstname.lastname@example.org if you have any questions.
For portal related questions contact our Portal Support Team at email@example.com or 510-297-0480.