December 04, 2014
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement
The California Department of Health Care Services (DHCS) has identified an error in its web application that was designed to allow physicians the ability to enter their usual and customary rates (UCR) for Child Health and Disability Prevention Program Services (CHDP) claims. Physicians who already entered their UCR data prior to November 26, 2014, will need to return to the portal and reenter their information.
The web app was developed to address a problem with the Affordable Care Act primary care rate increase unique to CHDP providers.
Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to process claims at the higher rates.
The error resulted in previously submitted data being overwritten when subsequent data was entered by other physicians. DHCS corrected the problem as of November 26, so physicians who entered their UCR prior to that date will need to visit the portal and reenter their information. Because of the glitch, DHCS has extended the deadline to submit physician UCR charges to January 16, 2015.
Click here for instructions on how to access the CHDP web app.