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eHEALTHsuite is not available Wednesdays from 6:00 p.m. to 8:00 p.m. due to weekly system maintenance.

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Section 1     Who to Call
Section 2     Member Services
Section 3     Member Complaints
Section 4     Claims
Section 5     Disputes and Grievances
Section 6     Ancillary Services
Section 7     Utilization Management
Section 8     Provider Services
Section 9     Quality Improvement
Section 10     Health Education, Cultural & Linguistic Services
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ACE Outpatient Authorization Request 50-1
ACE Inpatient Authorization Request 18-1
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   Health Matters MD
   Winter 2010
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Features in the Winter Issue
  • How providers can become more involved with our work
  • New Spanish Shapedown program successful
  • Nurse advice line provides 24-hour support
  • Incentive for annual well visits: children and teens


Past Issues of Health Matters MD
 Fall 2010
 Summer 2010
 Spring 2010
 Winter 2009
 Spring 2009
 Fall 2009
 Winter 2008
 Fall 2008
 Summer 2008
 Spring 2008
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General News and Announcements
02/01/2012 Dr. Fiona Donald Appointed Medical Director
01/17/2012 Important Meeting Announcement: Physician Reimbursement
12/14/2011 Emergency Room Services Reimbursement for MCE Members
11/17/2011 STD/HIV Quarterly Report
09/01/2011 Synagis Outreach Letter 2011 - 2012
09/01/2011 Improved eHEALTHsuite Member Eligibility Verification Portal
08/23/2011 Elimination of Dual Eligible Medi-Cal Capitation
07/18/2011 New Tdap shot required to enter 7-12th grade
07/01/2011 Important Information for ACE Contracted Providers
06/06/2011 PCP CareAdvantage Notification Change
03/28/2011 Change in Electronic Funds Transfers
04/01/2011 Change in Member ID Format
04/01/2011 HEALTHsuite Claims System Implementation
09/01/2010 Medi-Cal Nursing Facility Services Benefit Transferred to HPSM
05/01/2010 Mental Health Pharmacy Benefits
02/01/2009 New QIO for Medicare Case Review HSAG
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Pharmacy
11/10/2011 New Pharmacy Benefits Manager
08/01/2011 Reminder Notice—Diabetic Test Strips and Glucometers
07/01/2011 Cough and Cold Medications for Children Age 2 and Under
07/01/2011 Recent Changes to HPSM Medi-Cal Formulary
09/01/2010 CareAdvantage Step Therapy Criteria
09/01/2010 CareAdvantage Quantity Limits of Formulary Drugs
12/01/2008 New Pharmacy Benefits Manager
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Prior Authorizations
08/10/2011 CareAdvantage Prior Authorization Criteria
01/01/2011 Hospital and SNF prior authorization
02/01/2010 Authorization Requirement for Elective Admissions
03/01/2009 Prior Authorization Not Required for Pediatric Nebulizers
01/01/2009 Transportation Authorization Requirement
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Billing
09/01/2010 Claims Timeliness
08/01/2010 CPT HCPCS Update
05/01/2010 Medi-Cal Capitation Reports
12/01/2009 Administering Vaccines to CareAdvantage Members
03/01/009 Medical Supplies Conversion
11/01/2008 National Practitioner Identifier Required
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