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On Sept. 8, 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 cover the following service periods:
- 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
- Calendar Year 2023 Phase 1 (Jan. 1-June 30, 2023, service dates). The name of the file will be Name_CY2023P1
For any questions, or if you cannot access your data, you may reach out to DHCS directly at privatedp@dhcs.ca.gov.
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 health plans submit their provider network to DHCS broken out by each county on a monthly basis. The managed care plan’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. If you identify an error, please submit a corrected network provider file for that time period, please do not change the column when returning the contracting data file to DHCS.
Calendar Year 2022 Phase 1 (Jan. 1-June 30, 2022, service dates)
This file is the final pass at identifying contract status, and final payments for this phase will be based on this round of plan reporting. This contract flagging status file will be due no later than COB Oct. 20, 2023. DHCS expects hospitals and health plans to work together to address and attempt to resolve disagreements regarding contract status.
- 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 for any questions.
- Do not modify the structure of the data file in any way, including but not limited to:
- Do not add or delete any columns or rows.
- Do not alter or rename any column headers.
- Do not add additional tabs or split the data across multiple tabs.
- Do not modify the formatting of any data fields.
- Do not add additional encounter records to the data file.
- Do not modify data in any columns other than Hospital_Contract_Status.
- In particular, RECORD_ID is a 15-digit numeric string. Ensure you do not truncate, round, reformat, or otherwise change this string.
- Populate the Hospital_Contract_Status column only. Use “C” to indicate contracted, “N” to indicate non-contracted, or “H” to indicate a hospital-to-hospital contract. Do not use any other characters in this field.
- Submit your data to the appropriate health plan(s) with enough time so that the health plan(s) can in turn submit the data to DHCS by Oct. 20, 2023.
Calendar Year 2022 Phase 2 (July 1-Dec. 31, 2022, service dates)
As a reminder, 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, 2023. 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 2023 Phase 1 (Jan. 1–June 30, 2023, service dates)
As a reminder, the final due date for any new encounter data to be submitted to DHCS for consideration within the CY 2023 Phase 1 calculations is June 30, 2024. 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
Please see the following draft schedule of future data releases.
