Last week, the Department of Health Care Services (DHCS) released a new hospital directed payment data set, available via the Secure File Transfer Protocol site. The site is intended only for file transfers, and uploaded files will be deleted within 45 days. The data cover state fiscal year 2017-18 Phase 2 (Jan. 1–June 30, 2018), and the name of the new file will be “HospitalName_1718_P2.”
DHCS has flagged this as the “final pass” at identifying contract status for the state fiscal year 2017-18 Phase 2. Health plans will have until Oct. 25, 2019, to submit the final files to DHCS. CHA urges all hospitals to contact their health plan partners as soon as possible to begin the contract status reconciliation, as many health plans require an earlier deadline so they can meet the state’s deadline. Medi-Cal managed care directed payments will only be calculated using encounters that are considered in-network. There are no exceptions to this federal requirement.
Hospitals are also reminded that new or revised encounters for state fiscal year 2018-19 Phase 1 must be submitted by Dec. 31.