Provider Alerts

In accordance with Department of Health Care Services (DHCS) All Plan Letter (APL) 22-013, Health Plan network providers that have a state-level enrollment pathway must enroll in the Medi-Cal program, including ECM, CS, and certain ABA/BHT providers. State-level enrollment pathways are available either through the DHCS Provider Enrollment Division (PED) or another state department with a recognized enrollment pathway.

Health Plan verifies provider Medi-Cal enrollment at time of initial contracting and through the credentialing/re-credentialing process. Health Plan also conducts internal vetting and verification for any providers that do not have a pathway for Medi-Cal enrollment through DHCS.

A complete list of state-level enrollment pathways is available through the DHCS PED webpage, available at https://www.dhcs.ca.gov/provgovpart/Pages/Provider-Enrollment-Options.aspx.

For more information on APL 22-013, please visit https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-013.pdf

Enhanced Care Management (ECM) and Community Supports (CS) Providers

ECM and CS providers that have a pathway for enrollment through DHCS must be Medi-Cal enrolled to render services and receive reimbursement by Health Plan. Any ECM or CS provider that does not have a pathway for enrollment through DHCS will undergo internal verification and vetting by Health Plan at time of contracting and re-assessment.

Note: Justice-Involved providers must be Medi-Cal enrolled as a condition for contracting.

Applied Behavioral Analysis (ABA) Providers

Board certified behavioral analysts (BCBAs) and educational psychologists who provide behavioral health therapy (BHT) services to Medi-Cal members must enroll as Medi-Cal providers. In compliance with federal law, this requirement also applies to Qualified Autism Service (QAS) providers who render BHT services only to children in managed care.

QAS providers who are licensed providers (physicians, psychologists, physical therapists, occupational therapists, licensed marriage and family therapists, licensed clinical social workers, licensed professional clinical counselors, speech-language pathologists, and audiologists) do not need to re-enroll to bill for BHT services provided to Medi-Cal members in fee for service.

QAS providers can enroll in Medi-Cal through DHCS Pave Portal found here: https://pave.dhcs.ca.gov/sso/login.do. Additional details can be found on the DHCS website. QAS professionals and QAS paraprofessionals do not need to enroll.

Please note that enrolling in Medi-Cal does not obligate providers to see Medi-Cal fee-for-service members if they are currently only serving Medi-Cal managed care members, although DHCS sincerely hopes that providers will consider expanding services to Medi-Cal fee-for-service members.

For more information, including Frequently Asked Questions (FAQs), please visit the following linked DHCS bulletins:

• For Medi-Cal Enrollment Requirements and Procedures for Qualified Autism Service Provider Organizations and Individuals Offering Behavioral Health Treatment Services: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/page/medi-cal-enrollment-requirements-and-procedures-for-qualified-autism-service-provider-organizations-and-individuals-offering-behavioral-health-treatment-services

Updated Medi-Cal Coverage for Behavioral Health Treatment Services: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33416

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org