DHCS Reporting Requirements related to Provider-Preventable
| To: | Health Plan of San Joaquin (HPSJ) Providers |
| From: | Provider Services Department |
| Subject: | DHCS Reporting Requirements related to Provider-Preventable Conditions |
| Business: | Medi-Cal |
As of July 1, 2012 the Federal Affordable Care Act (ACA) requires that providers report all Provider-Preventable Conditions (PPCs) that are associated with claims for Medi-Cal payment or with courses of treatment furnished to a Medi-Cal patient for which Medi-Cal payment would otherwise be available. Providers must complete the attached one-page “Medi-Cal PPC Reporting Form DHCS 7107 (revised 2/15) for each PPC” and submit it to DHCS Audits and Investigation (A&I) Division. In addition, providers must also forward a copy of their completed form to HPSJ for review.
There are two types of PPCs:
- Other Provider-Preventable Conditions (OPPCs) in all health care settings
- Health Care Acquired Conditions (HCACs) in an acute inpatient setting
Please note that reporting PPCs for a Medi-Cal beneficiary does not preclude the reporting of adverse events and healthcare-associated infections (HAI) to the California Department of Public Health pursuant to Sections 1279.1 and 1288.55, of the Health and Safety Code. Providers do not need to report PPCs that existed prior to the provider initiating treatment for a Medi-Cal beneficiary, even if the provider does not intend to bill Medi-Cal.
HPSJ is required to participate in reporting PPC-related encounters by: screening and reviewing encounter data received by providers for presence of HCACs and OPPCs; identifying PPCs in encounter data that providers may have inadvertently overlooked and submitting the Form 7107 to DHCS A&I Division on behalf of the provider; and retaining the documents. HPSJ must also inform their providers that PPCs should be reported to DHCS A&I Division within five working days of discovery of the PPC and confirmation that the Medi-Cal beneficiary is enrolled in HPSJ. To forward a copy of your completed Form (DHCS 7107) to our UM Department, please fax to: San Joaquin (209) 762-4720 and Stanislaus (209) 762-4703.
Please direct any questions to our Provider Services Department by calling (209) 942-6340.
Attachment: “Medi-Cal PPC Reporting Form DHCS 7107 (revised 2/15) for each PPC”