Delay in DHCS PED Application Process

CPCA shared with DHCS feedback from health centers that in the past it traditionally took two to three weeks to have an application processed by Provider Enrollment Division (PED) but now it is taking two to three months.  Licensing & Certification has expedited their process but the delay for health centers to start billing claims appears to be with PED.

DHCS PED shared their department of 60 staff gets 1800 to 2400 applications per month and each are reviewed thoroughly and entered manually into their system.  They are hoping to have an electronic system soon.  There is no required timeframe for approving applications for FQHCs and RHCs.  On average it is taking 100 days to process an application.  PED stated currently there are only 11 applications pending from FQHC providers and the oldest is dated back to June 14th.  According to PED, they are sending communication to providers when they receive, approve and refer applications.

 

Medicare Administrative Contractors (MAC) Transition

NGS:

  • There was some misunderstanding regarding where NGS fits into the FQHC picture.  We have been assured NGS is not going to be servicing all FQHCs.
  • NGS will be continuing service to their existing clinics.  The California cutover date is July 13, 2013

      Current Contractor Number 00456 - J6 Contractor Number (new) 06014

  • New contractor number must be on claims starting July 13th for payment.  Please notify your clearinghouse.
  • The NGS J6 A/B MAC will handle all functions on and after these transition dates regardless of the claim date of service.

There will be an ask-the-contractor open door teleconference on June 25.

The link for the event details, click here

Noridian:

  • All Palmetto clinics (contracts) will be served by Noridian with the changeover dates of, Part A August 26, 2013 and Part B September 16, 2013.
  • All workloads currently held by the outgoing contractor at the time of cutover will be transferred to Noridian. This includes work in progress and work not yet started.
  • Any new sites requiring Medicare enrollment will be enrolled through Noridian starting August 26, 2013.

There will be an ask-the-contractor open door teleconference on July 24 at 2 p.m. PT.  The call-in number is 1-800-230-1059

No registration is required for these calls. Please call in ten minutes prior, all calls will start promptly at the time designated in the schedule listing. After placing the call, you will be asked for the following:

  • Conference Name
  • Facility Name
  • City and State
  • Number of people in attendance

The Noridian website is very user friendly and they have a good amount of information on the changeover available. They have meet & greets scheduled for the next couple of months along with web meetings.    https://www.noridianmedicare.com/eula.php?t=/je/

 

Medi-Cal Provider Enrollment

In January 2013 Medi-Cal began requiring FQHC providers be individually enrolled in Medi-Cal if they order, refer or prescribe.   Health centers enroll in the Medi-Cal program using the health center's NPI through L&C.  The health center's reimbursement is not changing.    This new process is for 3rd party providers to get reimbursed (like the pharmacies, specialists, etc.).  FQHC providers will need to be individually enrolled if they order, refer or prescribe.  If health center's do not individually enroll their providers, when they refer their patients to someone like a specialist, the specialist will not get paid which could cause the specialist to stop accepting referrals from the health center.  The same with pharmacy...if the health center does not individually enroll their providers (it won't stop payment to the health center) but the patient may not get their prescriptions filled.

 

If health centers have already enrolled their providers individually through Medicare there is no need to enroll individually through Medi-Cal for the ordering, referring and prescribing processes.

Application: Here.

More information: Here.

 

CPCA Staff Contact

For questions regarding provider enrollment, please contact Emily Shipman, Senior Program Coordinator of Health Center Operations, at eshipman@cpca.org.

 


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