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1. www.valleyhealthplan.org › members › benefits-andBenefits and coverage handbooks | Valley Health Plan | VHP

   www.valleyhealthplan.org › members › benefits-and

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   The Benefits and Coverage Handbook, also known as the Combined Evidence of Coverage or EOC, provides information about how to access services, member benefits, and your rights as a health care consumer. Benefits and coverage handbooks (EOC) for Covered California and IFP Plans 2025 Handbooks. English version ; 2024 Handbooks. English version

   • Billing information

     Medical claims submission. VHP must receive claims and...

2. www.valleyhealthplan.org › providers › billingBilling information | Valley Health Plan | VHP

   www.valleyhealthplan.org › providers › billing

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   Medical claims submission. VHP must receive claims and encounter data from contracted providers within ninety (90) days from the date of service. VHP has 45 working days from the date of receipt to reimburse, contest, or deny a claim. All paper claims for covered services provided to eligible Members must be submitted on CMS 1500 Form (for all ...

3. www.valleyhealthplan.org › benefits-and-coverageBenefits and coverage information for ... - Valley Health Plan

   www.valleyhealthplan.org › benefits-and-coverage

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   Here you will find Valley Health Plan's Summaries of Benefits and Coverage (SBC) for all Covered California and Individual & Family Plans (IFP). If you have questions about an SBC or need help with specific information listed on an SBC, please contact VHP's Member Services department at memberservices@vhp.sccgov.org or (888) 421-8444. Benefits ...

4. mcweb.apps.prd.cammis.medi-cal.ca.gov › fileMedical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov › file

   This section contains information about medical supplies, lists of products and program coverage (Welfare & Institutions Code [W&I Code], Section 14105.47). The information provided in this section applies to the medical supplies included on the lists below. The following spreadsheet contains the list of covered medical supply billing codes, units,

5. issuu.com › valleyhealthplan › docsCh 13: Claims & Billing Submission - Issuu

   issuu.com › valleyhealthplan › docs

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   A claim is a request by a provider for reimbursement, which is submitted either electronically or by paper for services rendered. A claim will be paid or denied with an explanation for the denial ...

6. issuu.com › valleyhealthplan › docsClaims - Issuu

   issuu.com › valleyhealthplan › docs

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   The electronic claims submission process is a more expedient and efficient way to process claims. In general, the claims submission requirements for electronic billing are the same as for paper ...

7. People also ask

   What is a medical supply billing code?

   • For Medi-Cal reimbursement, the medical supply HCPCS billing code on the claim must be appropriate for the product dispensed. The UPN, a unique product identifier, is required on claims for selected medical supply items. Claims for contracted medical supplies require the UPN, as provided on the appropriate list of contracted supplies.

   Medical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=mcsup.pdf

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   Are hemodialysis supplies reimbursable in California?

   • Medical supplies for chronic outpatient hemodialysis provided in renal dialysis centers and community hemodialysis units or for home dialysis are included in the all-inclusive rate (California Code of Regulations [CCR], Title 22, Section 51509.02) paid to the center or unit and are not separately reimbursable.

   Medical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=mcsup.pdf

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   Do medical supply claims require documentation of product cost?

   • Certain medical supply claims require documentation of product cost (an invoice, manufacturer’s catalog page or price list), as an attachment to the claim, for reimbursement. The product name must be clearly identifiable on the documentation.

   Medical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=mcsup.pdf

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   What is a health plan SBC?

   • According to the U.S. Government's marketplace website, the SBC is "a snapshot of a health plan's costs, benefits, covered health care services, and other features that are important to consumers." The goal of the SBC is to help members make informed health care decisions.

   Benefits and coverage information for Covered ... - Valley Health Plan

   www.valleyhealthplan.org/benefits-and-coverage-information-covered-california-and-ifp-members

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   Does Medi-Cal cover medical supplies?

   • Medi-Cal covers certain medical supplies, as prescribed by a physician, nurse practitioner, clinical nurse specialist or a physician assistant within the scope of practice and documented on a prescription. A recipient’s need for medical supplies must be reviewed by a prescriber annually.

   Medical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=mcsup.pdf

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   Are medical supply products reimbursable through Medi-Cal RX?

   • After January 1, 2022, these products transitioned to Medi-Cal Rx and are reimbursable through Medi-Cal Rx as a pharmacy-billed item. MCPs are required to provide or arrange for medically necessary medical supply products as a covered Medi-Cal benefit. Each MCP is unique in its billing and service procedures.

   Medical Supplies (mc sup)

   mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=mcsup.pdf

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8. s3-us-west-1.amazonaws.com › hp-prod-wp-dataSummary of Benefits and Coverage: What this Plan Covers ...

   s3-us-west-1.amazonaws.com › hp-prod-wp-data

   premiums, balance-billing charges, and health care this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the out–of–pocket limit. Will you pay less if you Yes. See Valley Health Plan This plan uses a provider network. You will pay less if you use a provider in the plan’s network.