Prospective Payment System (PPS)
Please visit the Department of Health Care Services for a complete listing of FQHC/RHC forms and instructions.
How to Request a Paid Claims Summary Report from Medi-Cal for an Annual Reconciliation:
This report is requested by health centers when preparing and completing reconciliation forms. DHCS Audits & Investigations uses the information on the PCSR when auditing reconciliation forms submitted by health centers. Please note there is a charge for each year requested for each NPI. The Medi-Cal system is only designed to extract in 11 or 12 months’ time frame.
Click here for the Claim Detail Request Form
Share Your DHCS Audits & Investigations On-Site Visit Feedback with CPCA
If you recently had either a positive or negative experience with the Department of Health Care Services (DHCS) Audits & Investigation’s team that you wish to share with CPCA, please complete a survey below. A&I leadership has indicated that they are open to addressing inconsistencies but must have specific details in order to provide training for their field auditors. CPCA will use the provided information to track trends and share the specific information with the A&I leadership team.
Revenue Cycle Management Program
CPCA is excited to announce that we have partnered with PMG, Inc. to bring our members unmatched expertise in revenue cycle management (RCM) for community health centers. By helping to increase revenue from third-party payers, this partnership will help your health center better deliver quality health care to those you serve.
Revenue Cycle Management Publishings
CPCA RCM Program Services
- Billing to specific payers (Medi-Cal, Medicare, and private insurance), including claims management and the assurance of proper patient registration, eligibility determination and provider credentialing
- Electronic remittance advice and posting to practice management system
- Denial management and reporting due to eligibility and coding issues
- Reporting and executive briefings on key performance indicators
- Ad Hoc
- Performance benchmarking against similar organizations
- Ongoing technical assistance and training programs
- Coding training for providers
- Front desk based on actual front end denial reason
- Medical records review and provider coding audits
- Best practice policy recommendations (self-pay, credit balance, etc.)
- Interface with Medi-Cal, health plans, and other private payers to ensure appropriate payment of claims
- Charge processing including pre-billing review
- Claim scrubbing and edits
- System configuration review
- Encounter form review and development
- Manages the overall RCM contract
- Provides ongoing program management
- Facilitates a smooth and streamlined transition into the program
- Ensures services meet or exceed expectations
- Provides PMG staff with direct technical assistance regarding California-specific billing requirements
- Communications with specific payers to ensure appropriate payment of claims
- Addresses participants’ questions and concerns
- Facilitates conversations between participants and PMG when necessary
CPCA also offers:
A "Revenue Cycle Check-Up Assessment " of current revenue cycle process and identification of opportunities and challenges. This assessment will be done for no cost! A more extensive onsite evaluation of your RCM processes with recommended changes to your current process.
In addition to services outline above, each Revenue Cycle Management member will receive a personal vendor management liaison to answer questions, expedite support issues, and ensure smooth transition to the RCM program.