22-820 Complete the DHCS PAVE Process to Participate in Our Medi-Cal Network

Date: 10/11/22

Provide proof of Medi-Cal FFS certification to qualify for participation in our Medi-Cal network

Effective September 1, 2022, new Medi-Cal physicians and other providers to California Health & Wellness Plan’s (CHWP’s) Medi-Cal network must have their Medi-Cal fee-for-service (FFS) certification prior to participating.

CHWP distributed provider update 19-386, New Medi-Cal Providers Must Show Proof of the DHCS Application, on May 16, 2019. The update informed new Medi-Cal physicians and other providers that CHWP allows participation in our network for the 120-day provisional period if proof was provided of their application with the Department of Health Care Services (DHCS) through the Provider Application and Validation for Enrollment (PAVE) system portal. The option to utilize the 120-day provisional period is no longer in effect.

Provider enrollment and certification requirements

The DHCS requires that all Medi-Cal managed care network physicians and other providers enroll in the Medi-Cal Program. Newly contracted physicians and other providers may only participate in CHWP’s Medi-Cal network if these conditions are met:

• Have proof of Medi-Cal FFS certification.
• Show they are active in the DHCS monthly enrollment files of Medi-Cal FFS providers.

Physicians and other providers currently in CHWP’s Medi-Cal network that do not meet the requirements set forth above will be subject to:

• Removal from CHWP’s Medi-Cal network or
• Termination of their CHWP Medi-Cal Participating Provider Agreement (PPA).

How to apply

Physicians and other providers are encouraged to register and enroll electronically via the DHCS PAVE system portal. Enrollment status can be tracked directly through the PAVE portal. PAVE technical support is available at 866-252-1949, Monday through Friday, 8 a.m. to 6 p.m. Pacific time, except holidays.

Use these online resources:

• DHCS provider enrollment options can be located by provider type on the DHCS website.
• PAVE frequently asked questions (FAQs).

Note: DHCS may take 180 days to review and approve non-PAVE enrollment applications.

Additional information

Physicians and other providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.

 

This Information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, and Ancillary Providers.