21-613 Understand Your Payment Reimbursement Process

Date: 08/30/21

Make sure you are getting paid in full

Per All Plan Letter (APL) 21-008 distributed by the Department of Health Care Services, California Health & Wellness Plan (CHWP) must apply an Alternate Payment Methodology (APM) to eligible medical, mental health and ambulatory services provided by their contracted Tribal Federally Qualified Health Centers (Tribal FQHC).

Here is what you need to know

Your payments will be issued directly from CHWP.

1 You will receive the regular claims payment.

2 A subsequent payment that makes up the APM rate difference will be issued.

Are you missing payments from CHWP?

If you are missing payments from CHWP, contact CHWP, at 877-658-0305.

What are the Tribal FQHC APM Rates?

Beneficiary	2021 rates
Dual Rate (Medi-Cal beneficiaries with full Medicare coverage or Medicare Part B only)	$371.49
Non-Dual Rate (Medi-Cal beneficiaries that do not have Medicare Coverage or have Medicare Part A only)	$519

Additional information

For questions regarding the information contained in this update, refer to APL 21-008 distributed by the Department of Health Care Services on May 12, 2021.

For all other questions, contact CHWP at 877-658-0305.