On Sept. 21, the Department of Health Care Services (DHCS) announced that it is delaying the implementation of the Provider 274 file for determining contracting status relevant to Medi-Cal managed care directed payment programs.
DHCS had originally planned to begin using the Provider 274 file, which Medi-Cal managed care plans use to report their provider networks to DHCS, for calendar year 2021 hospital directed payments as the initial filter in determining contracting status between hospitals and health plans. However, due to the significant changes and lack of time for hospitals and health plans to work together to correct any data errors, DHCS is delaying this implementation until it can ensure data accuracy and quality. DHCS now anticipates that the Provider 274 file will be used for network provider status determinations for state-directed payment programs starting in calendar year 2023.
Under federal rules and directed payment approvals, utilization-based Medi-Cal managed care directed payments such as the Private Hospital Directed Payment, are only eligible for contracted utilization. Therefore, it is critical that contracted services are appropriately and accurately identified as this determines the amount of directed payments each participating hospital receives.