American Specialty Health Plans for Acupuncture Services
As of April 1, 2017, California Health and Wellness will be expanding the network of acupuncture providers through American Specialty Health, Inc. (ASH Plans) for its members. Physicians and capitated participating physician groups (PPGs) must refer members to ASH Plans for acupuncture benefits. If a member is currently obtaining these services through an out-of-network provider, refer them to Member Services at 1-877-658-0305 for continuity of care.
Senate Bill (SB) 833 restored acupuncture on July 1, 2016, as a Medi-Cal benefit (California Code of Regulations (CCR), Title 22, Section 51308.5). Acupuncture services are limited to treatment performed to prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition. Acupuncture outpatient services are limited to two services in any calendar month (CCR, Title 22. Section 51304 [a]).
Members may self-refer for acupuncture for certain conditions, illnesses or injuries only covered in conjunction with services from a medical doctor (for example, chronic pain or nausea related to chemotherapy). Authorization is not required for acupuncture services for up to two visits per month. Prior authorization is required, if additional visits are needed during the same month.
California Health & Wellness members can self-refer to an ASH Plan preferred provider by contacting the California Health & Wellness Member Services line at 1-877-658-0305 and select the acupuncture option in the automated prompt. If you are interested in becoming an ASH provider, please call 1-888-511-2743 and a representative will assist you.
Providers are encouraged to access our provider portal online at www.cahealthwellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have question regarding the information contained in this update, please call Provider Services at 1-877-658-0305.