22-818 Complete the DHCS PAVE Process to Participate in Our Medi-Cal Network

Date: 10/11/22

Provide proof of Medi-Cal FFS certification to qualify for participation in our Medi-Cal network

Effective September 1, 2022, new Medi-Cal physicians and other providers to
Health Net’s* Medi-Cal network must have their Medi-Cal fee-for-service (FFS) certification prior to participating.

Health Net distributed provider update 19-384, New Medi-Cal Providers Must Show Proof of the DHCS Application, on May 16, 2019. The update informed new
Medi-Cal physicians and other providers that Health Net allows participation in our network for the 120-day provisional period if proof was provided of their application with the Department of Health Care Services (DHCS) through the Provider Application and Validation for Enrollment (PAVE) system portal. The option to utilize the 120-day provisional period is no longer in effect.

Provider enrollment and certification requirements

The DHCS requires that all Medi-Cal managed care network physicians and other providers enroll in the Medi-Cal Program. Newly contracted physicians and other providers may only participate in Health Net’s Medi-Cal network if these conditions are met:

• Have proof of Medi-Cal FFS certification.
• Show they are active in the DHCS monthly enrollment files of Medi-Cal FFS providers.

Physicians and other providers currently in Health Net’s Medi-Cal network that do not meet the requirements set forth above will be subject to:

• Removal from Health Net’s Medi-Cal network or
• Termination of their Health Net Medi-Cal Participating Provider Agreement (PPA).

How to apply

Physicians and other providers are encouraged to register and enroll electronically via the DHCS PAVE system portal.  Enrollment status can be tracked directly through the PAVE portal. PAVE technical support is available at 866-252-1949, Monday through Friday, 8 a.m. to 6 p.m. Pacific time, except holidays.

Use these online resources:

• DHCS provider enrollment options can be located by provider type on the DHCS website.
• PAVE frequently asked questions (FAQs).

Note: DHCS may take 180 days to review and approve non-PAVE enrollment applications.

Additional information

Physicians and other providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 800-675-6110.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.