19-268 Changes for Outpatient Hospital Claims Payments

Date: 04/11/19

Outpatient hospital claims fee schedule changing to align with the DHCS augmentation rule

On July 1, 2019, California Health and Wellness Plan (CHWP) will readjust its fee schedule to align with the Med-Cal fee schedule for outpatient hospital claims. Some past outpatient hospital claims submitted to CHWP were paid at a higher rate than required.  

The Medi-Cal fee schedule for outpatient hospital claims pays 43.44 percent higher, and CHWP will include the correct procedure codes starting July 1, 2019.

Hospitals that have already received payment from CHWP do not need to take action.

Moving forward, outpatient hospital claims payments will align with the actual 43.44 percent increase as based on the Department of Health Care Services (DHCS) augmentation rule.

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 at 1-877-658-0305.