News
Action Required: Submit Your Application for Medi-Cal Provider Enrollment to DHCS
Date: 07/17/18
On February 8, 2018, California Health & Wellness Plan (CHWP) distributed a provider update regarding Medi-Cal Provider Enrollment Changes. The update informed contracted Medi-Cal providers of requirements for submitting a Medi-Cal enrollment application to the Department of Health Care Services (DHCS), in accordance with DHCS All Plan Letter (APL) 17-019 and Title 42 CFR, Part 455, Subparts B and E.
REQUIREMENTS
As detailed in the April 10, 2018, provider update Changes to Application Submission Time Frame for Medi-Cal Provider Enrollment, and the April 17, 2018, certified letter distributed to contracted providers identified as not yet enrolled through DHCS, CHWP requires that providers’ enrollment with DHCS be approved by September 30, 2018. As a reminder, since this is a state requirement, failure to complete the application process and be enrolled by September 30, 2018, may result in termination from the health plan’s Medi-Cal provider network, in accordance with the provider’s CHWP Provider Participation Agreement (PPA). These requirements apply to all health plans participating in Medi-Cal managed care. Registering with DHCS allows providers to participate in Medi-Cal managed care for all health plans but does not obligate providers to participate in Medi-Cal fee-for-service (FFS).
If you received a letter from CHWP stating enrollment through DHCS was not found, and you are enrolled, submit verification of your DHCS enrollment by email to chwp_contracting@cahealthwellness.com or by fax to 1-855-463-4107. If you are not yet enrolled, but DHCS does not provide a pathway to enrollment for your provider type, CHWP will reach out to discuss processing your enrollment directly.
HOW TO APPLY
Providers who have not already enrolled with DHCS are encouraged to register and enroll electronically, as soon as possible, by logging in to the DHCS Provider Application and Validation for Enrollment (PAVE) system portal at https://pave.dhcs.ca.gov/sso/login.do. Application status can be tracked directly through the PAVE portal. PAVE technical support is available at 1-866-252-1949, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific time, except holidays. The following online resources are available for reference:
· Available and upcoming PAVE implemented provider types – www.dhcs.ca.gov/provgovpart/Documents/PAVE_Project_for_Provider_
Enrollment_Division/PAVE-Implementation-Roll-Out-113017.pdf.
· PAVE frequently asked questions (FAQs) –www.dhcs.ca.gov/provgovpart/Documents/PAVE_Project_for_Provider_
Enrollment_Division/PAVE_FAQ.pdf.
If the PAVE system enrollment is not an option for your provider type, DHCS application packages can be located by provider type on the DHCS website at www.dhcs.ca.gov/provgovpart/Pages/ApplicationPackagesAlphabeticalbyProviderType.aspx.
DHCS may take 180 days to review and approve non-PAVE enrollment applications.
ADDITIONAL INFORMATION
For additional information regarding Medi-Cal provider enrollment requirements, information on CHWP‘s monitoring of Medi-Cal enrollment status and additional resources, refer to the February 8, 2018, Medi-Cal Provider Enrollment Changes Provider Update available online in our Provider News section of the CHWP website: www.cahealthwellness.com/providers/provider-news.html.
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 within 60 days by telephone at 1-877-658-0305, or reach out to your provider relations or contracting representative.