News
19-386 New Medi-Cal Providers Must Show Proof of DHCS Application
Date: 05/16/19
Complete the DHCS PAVE process to particpate in CHWP’s Medi-Cal network
The Department of Health Care Services (DHCS) requires that all Medi-Cal managed care network providers enroll in the Medi-Cal Program. Newly contracted providers may only participate in California Health & Wellness Plan’s (CHWP’s) network if any of the following conditions are met.
- Show active in the DHCS monthly enrollment files of Medi-Cal fee-for-service (FFS) providers,
- Complete a like process from another managed care plan (MCP) that meets the requirements under All Plan Letter (APL) 17-019, which shows proof of their enrollment, or
- Be under a Provisional Enrollment that will allow participation in CHWP’s network for 120 days as long as the provider shows proof of their application with DHCS through the Provider Application and Validation for Enrollment (PAVE) system portal.
Provisional enrollment
Newly contracted providers may participate in CHWP’s network for up to 120 days pending the outcome of the DHCS screening and enrollment process. Providers must show proof they have applied with DHCS.
Proof of application means DHCS correspondence showing the provider’s application was submitted and accepted. Proof of application can be one of the following:
- Screen shots from PAVE.
- Written correspondence from DHCS.
Proof of applications must contain the provider’s National Provider Identifier (NPI), address and date the application was accepted. The applications can be sent along with provider profiles that providers regularly send to CHWP.
We monitor medical group/IPA rosters sent to CHWP. Any changes during the provisional period must be communicated with the plan to comply with DHCS and to update our records.
Failure to complete enrollment within the 120 days may result in the termination of that provider from the CHWP’s Medi-Cal network.
How to apply
Application status can be tracked through the PAVE portal. Contact PAVE technical support at 1-866-252-1949, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific time, except holidays.
Use these online resources:
- DHCS provider enrollment options can be located by provider type on the DHCS website at www.dhcs.ca.gov/provgovpart/Pages/Provider-Enrollment-Options.aspx.
- PAVE frequently asked questions (FAQs) –www.dhcs.ca.gov/provgovpart/Documents/PAVE_Project_for_Provider_Enrollment_Division/PAVE_FAQ.pdf.
Note: DHCS may take 180 days to review and approve non-PAVE enrollment applications.
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 in this update, contact CHWP at 1-877-658-0305.