About Us | Chapters | Advertising | Join
The Legal Department articles are not intended to serve as legal advice and are offered for educational purposes only. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise. Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in the article.
Fee-For-Service Medi-Cal Provider Enrollment Application Tips This article contains tips on how to successfully apply to become a Fee-For-Service provider with Medi-Cal.
Sara Jasper, JD Staff Attorney The Therapist March/April 2015
The Department of Health Care Services' (DHCS) Provider Enrollment Division began accepting Fee-For-Service Provider Applications from Licensed Marriage and Family Therapists in November of 2014. Since that time, CAMFT’s Legal Department has received numerous phone calls from members who are interested in enrolling. Below is information from www.medi-cal.ca.gov and the Provider Enrollment sections of the Medi-Cal website about how to successfully complete a provider application, common applicationerrors, and who to contact with questions.1
Tips for Successfully Completing a Medi-Cal Provider Application Package TIP #1 Submit a complete application package: A complete application package consists of the appropriate application form, a Medi-Cal Disclosure Statement (DHCS Form 6207), a Medi-Cal Provider Agreement (DHCS Form 6208), and all the required attachments. Current forms are available on the Medi-Cal website at www.medi-cal.ca.gov. Click the “Provider Enrollment” link.
TIP #2 Before completing the application forms, carefully read all form instructions.
TIP #3 Answer all questions, check boxes, lines, etc.: Do not leave blank spaces. Enter “N/A” if not applicable. Although stated as optional, including your Social Security Number(SSN) may hasten the application review process.
TIP #4 Be sure to include legible and current copies of the required documentation, including the following:
TIP #5 If the applicant is a sole proprietor and is not using a Tax ID Number (“TIN”), then the Social Security Number (“SSN”) must be included.
TIP #6 If the applicant is a corporation, include the “corporate number,” and “State incorporated,” as required on the form. Processing delays may be avoided by attaching a copy of the most recently filed Articles of Incorporation with the list of directors and officers, their titles, and percent of ownership and control interest. If the corporation is also a non-profit entity, indicate as such by checking the box “Non-profit Corporation,” and indicate if the type of non-profit is “government” or “non- government,” as well as including the corporation information.
TIP #7 If the business entity is a partnership, processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and including the following:
• A copy of the most current Partnership Agreement and a list of all partners and their percent of ownership or control interest (for General Partnerships), or Information identifying the General Partner, a copy of the most current Partnership Agreement(s), and a list of all partners and their percent of ownership or control interest (for Limited Partnerships).
TIP #8 Verify that all forms and required attachments,including the Medi-Cal Disclosure Statement, have an original signature in ink–preferably blue ink.
TIP #9 The application fee for LMFTs to become a Fee-For-Service Provider is $553. The fee must be paid in the form of a cashier’s check. The state regulations regarding these fees only exempt “physicians and nonphysician practitioners” from paying the application fee. According to the Department of Health Care Services, “non-physician practitioners” include physician assistants, nurse practitioners, certified midwives, but not other licensees, like LMFTs, psychologists, and LCSWs.
TIP #10 LMFT applicants are exempt from the requirement that applications be notarized. What Will Happen and What to Do After Submitting an Application A letter acknowledging receipt of your application package will be sent to your mailing address within 30 days. Retain this letter in your file. The letter includes a six-digit document number. Reference this number in any follow-up correspondence or telephone inquiry. Do not call the Provider Enrollment Division (PED) for the status of your application. Within 180 days following the receipt of your complete application package, you will receive written notification of one of the following:
Top Reasons for Denying a Medi-Cal Provider Enrollment Application
Incorrect application forms Title 22, California Code of Regulations (CCR), Section 51000.30, requires applicants to use the correct application for their provider type. There is also a chart on the Provider Enrollment page showing which application forms should be used by a specific provider type. The Department typically revises applications through the authority granted by Welfare and Institutions (W&I) Code, Section 14043.75.
Applicant fails to respond timely W&I Code, Section 14043.26(e)(2)(A), indicates that if an applicant does not resubmit an application package that was noticed as incomplete within 35 days, the application package shall be denied by operation of law.
Failure to remediate discrepancies W&I Code, Section 14043.26(f)(2)(A), indicates that a deficiency letter for an incomplete application shall identify the discrepancies or failures and whether remediation can be made or not, and if so, the time period within which remediation must be accomplished. Failure to remediate discrepancies and failures as prescribed by the Department, or notification that remediation is not available, shall result in denial of the application by operation of law.
Fraud and abuse W&I Code, Section 14043.37, indicates that the Department may complete a background check on applicants for the purpose of verifying the accuracy of the information to the Department for the purposes of enrolling in the Medi-Cal program and in order to prevent fraud or abuse. The background check may include, but is not limited to, the following:
No established place of business W&I Code, Section 14043.26(d)(4)(D), and Title 22, CCR Section 51000.60 indicate that failure to have an established place of business at the business address for which the application was submitted at the time of any additional inspection or review conducted pursuant to any statute or regulation governing the Medi-Cal program, shall warrant denial of the application. Applicants must comply with established place of business requirements unless the practice of the provider’s profession or delivery of services, goods, supplies or merchandise are rendered or delivered at locations other than those listed on the application and this practice or delivery has been disclosed in the application package and approved by the Department.
Failure to Disclose W&I Code, Section 14043.2(a), indicates that failure to disclose the required information, or the disclosure of false information, shall result in denial of the application for enrollment or make the provider subject to temporary suspension from the Medi-Cal program, which shall include temporary deactivation of all provider numbers used by the provider to obtain reimbursement from the Medi-Cal program.
Provider does not hold the required license W&I Code, Section 14043.26(d)(4)(B), indicates that an application package is denied when an applicant lacks a license necessary to perform the health care services or to provide goods supplies or merchandise directly or indirectly to a Medi-Cal recipient, within the applicable provider of service category or subgroup of that category.
Who to Contact With Application Questions An applicant may contact the Telephone Service Center at (800) 541-5555, the Provider Enrollment Message Center at (916) 323-1945, or submit written question(s) to the Department of Health Care Services, Provider Enrollment Division, MS 4704, P.O. Box 997412, Sacramento, CA 95899-7412 or via email at PEDcorr@dhcs.ca.gov. DHCS can assist applicants by providing guidance on what forms to complete but DHCS staff may not provide advisory opinions regarding completion of applications. You may also want to refer to my article titled, “How to Become a Fee-For-Service Medi-Cal Provider” that is available on the CAMFT website at www.camft.org.
Sara Jasper, JD, is a staff attorney for CAMFT. Sara is available to answer member calls regarding legal, ethical, and licensure issues.
Endnotes 1 Note: As of early February, 2015, the reimbursement rates have not been published. CAMFT is in regular contact with DHCS to request that these rates be immediately published.