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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

Preventable Conditions

Date: 05/23/17

Federal regulations and state law require that providers report all provider-preventable conditions (PPCs) associated with claims for Medi-Cal beneficiaries that did not exist prior to the provider initiating treatment. State law also prohibits reimbursement for services to treat the PPC. The Department of Health Care Services (DHCS) is changing its process for reporting PPCs.

Reporting Changes

Providers can now report PPCs for Medi-Cal electronically through the DHCS secure online reporting portal. The online reporting process is replacing the paper Medi-Cal PPC Reporting Form (DHCS 7107). Effective June 1, 2017, DHCS will no longer accept paper copies of the form; however, providers are still required to submit the information to the health plan. Prior to submitting the form online, providers can use the Print Screen function to create a paper copy for submission to California Health & Wellness. Instructions on how to submit PPCs and the link to the secure online portal.

PPC Types

The Centers for Medicare & Medicaid Services (CMS) defines two types of PPCs:

  • Health care-acquired conditions (HCACs), also known as hospital-acquired conditions (HACs).
  • Other provider-preventable conditions (OPPCs).

Unlike HCACs, OPPCs are not confined to an inpatient setting, but may occur in either an inpatient or outpatient setting. Outpatient settings include hospitals, outpatient departments, clinics, ambulatory surgical centers (ASCs), federally qualified health centers (FQHCs), and physicians' offices. CMS and DHCS identify three OPPCs for Medi-Cal:

  • Wrong surgery/invasive procedure.
  • Surgery/invasive procedure performed on the wrong body part.
  • Surgery/invasive procedure performed on the wrong patient.

Affected Providers

Inpatient acute care hospitals must report all PPCs and OPPCs. All other facilities that conduct surgery or invasive procedures only report OPPCs. If a facility has both an acute inpatient care hospital unit and a skilled nursing facility (SNF) unit, the facility must report PPCs and OPPCs.

For additional information about the reporting requirements for PPCs, including payment adjustments, visit the Medi-Cal Guidance on Reporting Provider-Preventable Conditions page on the DHCS website.

If you have questions regarding the information contained in this update, contact the California Health & Wellness Provider Services Call Center at
1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number).​