19-552 Extra Payment for Medical Pregnancy Termination Services
Date: 10/07/19
Extra Payment for Medical Pregnancy Termination Services
You may receive a supplemental payment based on claims you submitted
You may receive an extra payment if your office sent claims for CPT codes 59840 or 59841 during these state fiscal years (SFYs):
· 2017–2018
· 2018–2019
· 2019–2020
The payments below apply to providers who are eligible to offer and bill claims with the listed CPT codes during the SFYs above. A W-9 form is required for payment.
CPT code | Description | Reimbursement |
59840 | Induced abortion, by dilation and curettage | Up to $400 |
59841 | Induced abortion, by dilation and evacuation | Up to $700 |
If you have already been paid for past claims, your extra payment will be sent to you minus the amount you have already been reimbursed for the claim. This will bring your payment total to the amounts above.
Supplemental payments will be held until they reach a minimum amount of $5.
Supplemental payment for delegated providers will be the difference between the total reimbursement rate per rate adjustment guidance and the Medi-Cal fee schedule. This payment will be sent by California Health & Wellness Plan (CHWP). Contracted physicians with CHWP will also receive payment directly from CHWP.
Submit your W-9 form to get paid
A W-9 form is required. After receiving the completed W-9 form, payments take about five weeks to process and send out. The W-9 form must include your:
· National Provider Identifier (NPI) – If two NPI numbers are used (individual and group), include both NPI numbers where space is available.
· Individual taxpayer identification number (TIN).
Example
Attached is a W-9 form. You can also download it from the Internal Revenue Service (IRS) website at www.irs.gov/pub/irs-pdf/fw9.pdf with complete instructions.
Send a current or updated W-9 by email or fax:
HNCA_W9_Submissions@CENTENE.COM (Clearly add the words “Prop 56 W9” in the subject line.) | |
FAX | 1-833-794-0423 (Include a cover sheet and clearly add the words “Prop 56 W-9” and “PROTECTED HEALTH INFORMATION.”) |
Women’s health – Pregnancy termination
Through Proposition 56, Supplemental Payment Methodologies, the Department of Health Care Services (DHCS) approved supplemental payments for medical pregnancy termination services in both the Medi-Cal fee-for-service and Medi-Cal managed care delivery systems. DHCS began payment to health plans in March 2019. CHWP began payment to providers in July 2019.
Additional information
For additional information on these services, refer to the DHCS website at www.dhcs.ca.gov.
For all other questions about the status of your W-9 form, requesting a remittance advice (RA) or about Prop 56 payments, contact CHWP at 1-877-658-0305.