Medi-Cal Provider Enrollment Changes

Date: 02/08/18

Effective January 1, 2018, in accordance with the Department of Health Care Services (DHCS) All Plan Letter (APL) 17-019 and Title 42 CFR, Part 455, Subparts B and E, California Health & Wellness Plan (CHWP) is directing their network providers to complete the DHCS screening and enrollment process as a requirement to participation.¹

BACKGROUND
In accordance with Title 42 CFR, Part 455, Subparts B and E, DHCS has issued provider screening and enrollment requirements for Medi-Cal managed care plans (MCPs) that limit participation in CHWP's provider network to those who meet the DHCS screening and enrollment requirements.

REQUIREMENTS
CHWP is requiring that all participating providers who are not enrolled in Medi-Cal submit a Medi-Cal enrollment application to DHCS within 45 calendar days of this notice and have their Medi-Cal enrollment applications approved by DHCS within the DHCS required time frame following submission.

Since this is a state regulation, failure to apply within the 45 calendar day time frame and be approved by DHCS within its enrollment guidelines and time frame will result in the provider’s termination from the CHWP provider network. These requirements apply to all health plans participating in Medi-Cal. As a result, registering with DHCS will ensure providers are able to participate in Medi-Cal managed care for all health plans. The requirement does not obligate providers to participate in Medi-Cal fee-for-service (FFS).

Enrollment in the DHCS Medi-Cal program does not affect the reimbursement terms of the Participating Provider Agreement (PPA) and, once enrolled, providers will continue to receive the same reimbursement specified in the PPA.

DHCS application packages can be located by provider type on the DHCS website at www.dhcs.ca.gov/provgovpart/Pages/ApplicationPackagesAlphabeticalbyProviderType.aspx.

QUESTIONS
A list of frequently asked questions (FAQs) regarding provider application can be found on the DHCS website: www.dhcs.ca.gov/provgovpart/Pages/ApplicationProcessingQuestions.aspx.

MONITORING MEDI-CAL ENROLLMENT STATUS
CHWP will continue to monitor Medi-Cal enrollment status for participating providers, practitioners and first-tier, downstream and related entities (FDRs). In addition, delegated independent practice associations (IPAs) who are contracting with CHWP must verify that their network of providers involved in servicing Medi-Cal members are enrolled in Medi-Cal through DHCS.

Providers can contact the DHCS Provider Enrollment Division (PED) to check the status of their application at www.dhcs.ca.gov/provgovpart/Pages/ContactPED.aspx.

A profile of providers enrolled in Medi-Cal FFS is available on the California Health and Human Services (CHHS) open data portal at https://data.chhs.ca.gov/dataset/profile-of-enrolled-medi-cal-fee-for-service-ffs-providers-as-of-june-1-2017.

For additional information about enrollment requirements, visit the DHCS Provider Enrollment website at
http://files.medi-cal.ca.gov/pubsdoco/prov_enroll.asp.

RESOURCES

DHCS APPLICATION PACKAGES
www.dhcs.ca.gov/provgovpart/Pages/ApplicationPackagesAlphabeticalbyProviderType.aspx

FAQs REGARDING APPLICATION
www.dhcs.ca.gov/provgovpart/Pages/ApplicationProcessingQuestions.aspx

STATUS OF APPLICATION
www.dhcs.ca.gov/provgovpart/Pages/ContactPED.aspx

PROFILE OF ENROLLED FFS PROVIDERS
https://data.chhs.ca.gov/dataset/profile-of-enrolled-medi-cal-fee-for-service-ffs-providers-as-of-june-1-2017

ADDITIONAL INFORMATION
Providers are encouraged to access CHWP’s 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 questions regarding the information contained in this update, contact CHWP Customer Service at 1-877-658-0305, or reach out to your Provider Relations or Contracting Representative.

¹The APL can be found in full on the DHCS website at www.dhcs.ca.gov/formsandpubs/Pages/AllPlanLetters.aspx