Provider Frequently Asked Questions (FAQs)

Contact your Regional Contractor's office to arrange individualized technical assistance. You can also access downloadable tools including annotated worksheets with instructions and the Step-by-Step User's Guide from the CDP Tools and Links page.

Yes, responses to both questions is strongly encouraged. Please avoid selecting "Unknown" race.

Clicking the "UNLOCK" button will allow changes to the previously submitted information WHEREAS clicking the "ADD NEW" button will create an entirely new, blank form.

* "UNLOCK FIELDS AND EDIT THIS RECORD" is used to change data on an existing screening/data cycle that has already been submitted.

• For example, changing the mammogram date on the Screen form because it was accidentally entered incorrectly.

* "ADD NEW BREAST (or CERVICAL) SCREENING RECORD" is used to enter data for a new screening/data cycle. Note that the existing, previously submitted record is not erased or deleted from the system -- instead an additional record is now being added.

• This includes the next mammogram or Pap test after an unsatisfactory result as well as CBEs, mammograms or Pap test that are performed as Short-term Follow-up of a prior study.

* Select Benign if the CBE revealed a finding not of concern for breast cancer.

* Select Probably benign if the CBE revealed a finding that does not require an immediate work-up for cancer, but re-evaluation in 3-6 months is intended.

* Tools to assist the clinician include the downloadable Breast Cancer Diagnostic Algorithms and the CBE Documentation Form.

* Select Probably benign if the CBE revealed a finding that does not require an immediate work-up for cancer, but re-evaluation in 3-6 months is intended.

* Abnormality, rule out breast cancer should be selected to indicate a CBE with abnormal findings suspicious for breast cancer. An abnormal CBE requires immediate diagnostic procedure(s) (e.g., ultrasound, surgical consult, biopsy, etc.) even after a Negative or Benign mammogram.

* Clinical tools to assist the PCP include the downloadable Breast Cancer Diagnostic Algorithms and the CBE Documentation Form.

Normally Short-term Follow-up is suggested, but the mammogram result should be considered as well:

* If the associated mammogram is normal/benign (e.g. BI-RADS 1, 2 and 3), then the 'Next Step' is often Short-term Follow-up.

* If the associated mammogram is Abnormal (e.g. BI-RADS 4, 5 and 0), Immediate Work-up is required.

* Even with benign or normal mammogram results, the provider may select Immediate Work-up as the 'Next Step' due to high risk or the woman’s concerns.

Since this was a short-term follow-up mammogram, you will need to start with a new Breast Screen form by clicking the “ADD NEW BREAST SCREENING RECORD” button at the bottom of the Breast Screen online form.

* If the CBE was normal within the past 12 months – you can submit the CBE as “not needed” on the new Breast Screen form.

* If the initial CBE was not normal, you can select “needed but not performed” for the 6 month follow-up CBE.

* Submit the 6 month follow-up mammogram result and a 'Next Step' based on that result.

Always submit result that is more severe - in this case the BI-RADS 4, Suspicious Abnormality.

* Find the correct patient in the online application

* Click the "ADD NEW BREAST (or CERVICAL) SCREENING RECORD" button at the bottom of the online Screen form to begin. You will see a new, blank Screen form.

* Enter data for the second screening cycle and click "Submit" to save the new record.

* Recertify the patient after eligibility has expired and submit both CBE & mammogram results at the same time on a new Breast Screen form.

* Submit mammogram on the Breast Screen form

* Select 'Next Step' as Immediate Work-up

* Submit ultrasound and FNA on a Breast Follow-up form. The dates can be the same as the mammogram date entered on the Screen form

* Select Work-up complete for 'Breast Cancer Diagnosis Status'

* Select Not Cancer for 'Breast Cancer Final Diagnosis'

* Enter the date the procedures were performed as the 'Date of this Diagnostic Status' and 'Date of this Diagnosis'

Per CDP:EWC policy, if a PCP bills for services, they must enter and submit complete screening and follow-up data for the case.

* Begin a Breast Screen form by selecting No to the first question: 'Breast Cancer Screening Performed through Cancer Detection Programs: Every Woman Counts?'

* Enter the CBE and mammogram information from the other program, recording the associated results.

* Indicate that the 'Next Step' is Immediate Work-up so that the patient can complete diagnostic procedures not covered under the other program. Record the subsequent CDP:EWC procedures and diagnosis on a Breast Follow-up form.

No. Follow-up data is required only for a 'Next Step' of Immediate Work-Up.

* When a woman returns for her short-term follow-up visit, submit those procedure(s) on a new Breast Screen form by clicking the “ADD NEW BREAST (or cervical) SCREENING RECORD” button at the bottom of the Breast Screen (or cervical) online form.

Yes – as long as the patient has completed all planned immediate workup procedures, and a final diagnosis is reached, the data cycle ends. Planned short-term follow-up (e.g., recommendations for an ultrasound in 6 months), ends the current screening/data cycle.

* Enter the immediate work-up information on a Follow-up form.

* Record the dates of the diagnostic procedures.

* Select Work-up complete for 'Breast Cancer Diagnosis Status' and enter the date of the final immediate work-up procedure as the diagnostic status date.

* Select Not Cancer for 'Breast Cancer Final Diagnosis' and enter the date of the final procedure as the 'Date of the final diagnosis'.

CDC wants the program to track the number of unsatisfactory Pap tests.

Per CDP:EWC policy, if a PCP bills for services, they must enter and submit complete screening and follow-up data for the case.

* Begin a Cervical Screen form by selecting No to the first question: "Cervical Cancer Screening Performed through Cancer Detection Programs: Every Woman Counts?”

* Enter the Pap test information from the other program, recording the associated results.

* Indicate that the 'Next Step' is Immediate Work-up so that the patient can complete diagnostic procedures not covered under the other program. Record the subsequent CDP:EWC procedures and diagnosis on a Cervical Follow-up form.

Although CDC does not require immediate work-up for BI-RADS 3 (probably benign) mammogram results, the CDS Algorithm states that BI-RADS 3 always require further evaluation despite a normal/benign CBE.

* If the CBE result is no breast abnormality or benign breast condition, a BI-RADS 3 requires follow-up in 3 - 6 months. Select Short-term Follow-up as the 'Next Step' and submit the next procedures and results on a new Breast Screen form when the woman returns.

* To receive case management fees, the data from the first screening and the next screening (short-term follow-up) must be submitted. To submit the second (short-term follow-up) screening data, click the “ADD NEW BREAST SCREENING RECORD” button at the bottom of the Breast Screen online form to create a blank Screen form for the short-term follow-up procedures.

* Remember, case management is reimbursable once per patient per 365 days.

Normally, a Follow-up form is only indicated when the 'Next Step' was Immediate Work-up. However in this case, a Follow-up form can be submitted with a 'Diagnostic Status' of Lost to Follow-up as long as appropriate attempts to contact the patient have occurred (2 phone calls and a certified letter).

* Find the correct patient – Patient A -- and enter her data to bring the record up to date

* Patient B’s record cannot be corrected or deleted!! Data entered in error may result in a site visit from program staff, so it is very important to verify that you are working with the correct patient’s record.

Data can be changed (corrected), but cannot be cleared from a record. For example, if a Follow-up form was submitted when no follow-up actually occurred, the inappropriate information cannot be deleted or cleared and the patient's record will always be in error. It is very important that the correct patient’s record is selected when entering data.

* Click the "UNLOCK FIELDS AND EDIT THIS RECORD" button at the bottom of the Breast Screen online form.

* Enter the correct mammogram result and click "Update" to submit the record again.

* Find the correct recipient in the online application

* Click the "UNLOCK FIELDS AND EDIT THIS RECORD" button on the Follow-up form

* Enter her diagnostic procedure dates

* Change the Lost to Follow-up or Refused selection and select new 'Breast Cancer Diagnostic Status,' add a 'Final Diagnosis' and change the associated Diagnostic Status and Final Diagnosis 'Dates'

California licensed clinicians and community clinics or other agencies interested in participating in Cancer Detection Programs: Every Woman Counts should visit the Cancer Detection Section's Provider Support webpage and view the Program Manual (PDF). Contact the clinical coordinator at your Regional Contractor's office for more information.

After you have become an enrolled program provider your local Regional Contractor will assist you with orientation to Cancer Detection Programs: Every Woman Counts. You may also wish to review the Program Manual (PDF) found on the Cancer Detection Section's Provider Support webpage and the Step-By-Step Provider User Guide (PDF) offered within the Publications section of the Medi-Cal website.

Program requirements for participating providers can be found in the Cancer Detection Programs: Every Woman Counts Program Manual (PDF) on the Cancer Detection Section's Provider Support webpage.

Cancer Detection Programs: Every Woman Counts will reimburse program providers for a number of breast cancer and cervical cancer screening and diagnostic procedures provided to eligible women enrolled in the program. You will find information about reimbursable procedures and other program components in the Cancer Detection Programs: Every Woman Counts section of the Medi-Cal Manual (please wait 1-2 minutes for download). For billing support call 1-800-541-5555.

The clinical coordinator at your Regional Contractor's office is your local contact for the program. Find phone numbers and addresses on the Cancer Detection Section website.

1-800-511-2300 Women who would like to receive free breast cancer or cervical cancer screening or diagnostic services can call the toll free consumer hot-line at 1-800-511-2300. Cancer Detection Programs: Every Woman Counts eligibility criteria and provider information is offered in English, Spanish, Cantonese, Mandarin, Korean and Vietnamese. Service is available Monday through Friday, from 9 am to 7 pm. Clinicians may distribute this number freely.

Yes. The Cancer Detection Section Professional Education Unit sponsors a course for licensed California clinicians titled Clinical Breast Examination: Proficiency and Risk Management. The course is offered periodically throughout the State and is available in two formats. For details and schedule information, visit the CBE Training section of this website (online registration is available).

Visit the CME Center on this website for information on a variety of training opportunities. Your Regional Contractor can also assist you.

Yes. You will find algorithms and guideline information to assist you with the work-up of abnormal findings for both breast cancer and cervical cancer in the Cancer Screening and Diagnosis section of this website.