The Department of Health Care Services (DHCS) has released three new hospital-directed payment data sets, available via the Secure File Transfer Protocol site (the site is only intended for file transfers, and uploaded files will be deleted within 45 days).
The data cover:
- State fiscal year 2018-19 Phase 1 (July 1, 2018 – December 31, 2018 service dates)
- State fiscal year 2018-19 Phase 2 (January 1, 2019 – June 30, 2019 service dates)
- Bridge period 2019-20 Phase 1 (July 1, 2019 – December 31, 2019 service dates)
The data file with SFY 2018-19 Phase 1 (July 1, 2018 – December 31, 2018) is in its “final pass” at identifying contract status. Due to the uncertainty that COVID-19 is causing throughout the state, DHCS has extended the deadline for reporting contract status to DHCS until close of business on April 24. It is important to remember that some plans have internal deadlines that are shorter than the DHCS deadline of April 24. With that in mind, every hospital should reach out to Medi-Cal managed care plans they hold contracts with to ensure they do not miss their deadlines to reconcile contractual differences.
Any encounters that are not accurately populated with a contract status flag (“C” indicates contracted, “N” indicates non-contracted, and “H” indicates a hospital-to-hospital contract) will be defaulted by DHCS to “N” — non-contracted — and will not count toward any directed payments.