CHA News

DHCS Releases Private Hospital Directed Payment Encounter Files

On March 10, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol site. It is important for hospitals to download these files as soon as possible as the site is only intended for file transfers, not ongoing storage, and uploaded files will be deleted within 45 days.  

The files include:    

  • Calendar Year 2021 Phase 2 (July 1-Dec. 31, 2021, service dates). The name of the file will be Name_CY2021P2 
  • Calendar Year 2022 Phase 1 (Jan. 1 June 30, 2022, service dates). The name of the file will be Name_CY2022P1 
  • Calendar Year 2022 Phase 2 (July 1- Dec. 31, 2022, service dates). The name of the file will be Name_CY2022P2 

To assist DHCS’ provider data quality improvement initiative, Managed Care Provider Network 274 data — as outlined in All Plan Letter (APL) 16-019 — has been added to these data sets. Medi-Cal managed care plans (MCPs) submit their provider network — broken out by each county — to DHCS each month. The MCP’s submission is mapped to DHCS network adequacy standards as described in APL 19-002. The PROV_274 data column is included in all hospital directed payment data sets. This column contains a Y if the NPI, REND_OPERATING_NPI, or REF_PRESC_NPI is a network provider identified in the network provider file from the month of service. An N will signify that the NPI, REND_OPERATING_NPI, or REF_PRESC_NPI is not on that month’s network provider file.  

Calendar Year 2021 Phase 2 (July 1-Dec. 31, 2021, service dates) 

This file is the final pass at identifying contract status. This contract flagging status file is due no later than COB on April 14. DHCS expects hospitals and health plans to work together to address and attempt to resolve disagreements regarding contract status. 

  • PLEASE NOTE: The FQ_Check column is included in this file. This column will be populated with an X for private hospitals with encounters being removed by having an FQ/RHC NPI and reporting both FQ/RHC and non-FQ/RHC outpatient utilization. The impacted hospitals should have already received communication on this issue. Hospitals do not update this column; it is up to the plans to make all adjustments. If you have encounters in your file with this X, please reach out to PrivateDP@dhcs.ca.gov with any questions. 
  • Submit your data to the appropriate health plan(s) with enough time so that the health plan(s) can submit the data to DHCS by April 14

Calendar Year 2022 Phase 1 (Jan. 1-June 30, 2022, service dates) 

The final due date for any new encounter data to be submitted to DHCS for consideration within the CY 2022 Phase 1 calculations is June 30. Please note that plans may set earlier due dates for receiving the data in order to be able to process and submit it to DHCS by the deadline. 

DHCS expects plans and participating hospitals to work together to identify and address deficiencies in the accuracy and/or completeness of the encounter data. 

Calendar Year 2022 Phase 2 (July 1-Dec. 31, 2022, service dates) 

The final due date for any new encounter data to be submitted to DHCS for consideration within the CY 2022 Phase 2 calculations is Dec. 31. Please note that plans may set earlier due dates for receiving the data in order to be able to process and submit it to DHCS by the deadline. 

DHCS expects plans and participating hospitals to work together to identify and address deficiencies in the accuracy and/or completeness of the encounter data. 

FUTURE DATA RELEASES 

The following is a draft schedule of future data releases: