Information for Providers

 
How do I become a EWC Provider?
Enroll into the program through Every Woman Counts. Contact Liza Navarro, the Clinical Coordinator, at LNavarro@ochca.com or (714) 834-6193, to get an application. Not all prospective providers are eligible for enrollment.
What services are covered by EWC?

Breast Cancer Screening and Diagnostic Services including:

  • Office Visit – Breast Screening
    Clinical Breast Exam (CBE); Repeat exams are allowed for follow–up of abnormal findings.  
  • Screening Mammogram
    Each PCP can order one screening mammogram per year for each individual age 40 and older.
  • Abnormal CBE/Mammogram Results
    When a CBE or screening mammogram is abnormal, a diagnostic mammogram work–up should be initiated, which may include a diagnostic mammogram and/or other diagnostic procedures.
  • Diagnostic Mammogram
    A diagnostic mammogram is reimbursable when either the CBE or the screening mammogram is abnormal and when an individual of any age has a breast symptom (i.e., lump, pain, discharge). Repeated diagnostic mammograms, if indicated, are also reimbursable.
  • Other Diagnostic Services
    Additional reimbursable breast diagnostic services include ultrasound, Fine Needle Aspiration (FNA), core needle and/or excisional biopsies. Diagnostic services are reimbursed until pathologic diagnosis of cancer or not cancer is made.  Cancer treatment is not covered by EWC. The individual can be referred to the Breast and Cervical Treatment Program (BCCTP) for assistance with cancer treatment costs. For more information about the BCCTP, visit their website.
Cervical cancer screening and diagnostic services for women age 21 and older including:
  • Cervical screening
    Pelvic exam and Pap Smear
  • Colposcopy
    A colposcopy and up to four biopsies, Endocervical Curettage (ECC) billed as biopsy, are reimbursable when either a Pap Smear or the visual inspection of the cervix  is abnormal
  • Diagnostic services are covered until final pathology diagnosis is made.
Where should I send my EWC patients for mammograms?
Primary Care Providers can refer patients to any radiology facility that is a Medi-Cal provider in good standing and licensed in the State of California. These Referral Providers do not enroll patients into EWC or sign a provider agreement. Also you can contact Liza Navarro (714-834-6193 or LNavarro@ochca.com) to request a copy of the Radiology Referral List.
I need help with billing.

Claims for EWC services provided can be submitted either hard copy or electronically using the CMS-1500 or UB-04. Providers who choose to submit hard copy claims must send them to the appropriate address for their claim type, as follows:

Medi-Cal Services (CMS-1500) Outpatient Services (UB-04)
Conduent
P.O. Box 15700
Sacramento, CA 95852-1799
Conduent
P.O. Box 15600
Sacramento, CA 95852-1600
For questions about EWC claims or claims procedures, call the Billing Support: 1-800-541-5555.
Where can I get more information for Primary Care Providers?
View the Every Woman Counts page for Primary Care Providers' Program Manuals & Information.
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