What’s happening: On March 8, the California Department of Health Care Services (DHCS) released the latest round of Medi-Cal managed care utilization data to hospitals and health plans. These data are used to determine the amount of funding each hospital will receive in the Private Hospital Directed Payment Program.
What else to know: Hospitals should download their data from the DHCS secure site as soon as possible because uploaded files will be deleted within 45 days. Hospitals should compare these data to their own utilization records and work with their contracted Medi-Cal managed care plans to reconcile any differences in order to get full credit and payment for contracted services provided during the program period. Medi-Cal managed care plans have approximately five weeks to return the data to DHCS. The uploaded files cover the following service periods:
- Calendar year 2022, phase 2 (July 1, 2022 – Dec. 31, 2022, service dates)
- Calendar year 2023, phase 1 (Jan. 1, 2023 – June 30, 2023, service dates)
- Calendar year 2023, phase 2 (July 1, 2023 – Dec. 31, 2023, service dates)
Hospitals that did not receive an email from DHCS with this information and further instructions, or that are having challenges accessing data from the secure site, can contact DHCS at PrivateDP@dhcs.ca.gov.
This data release is the sixth and final opportunity to reconcile data with Medi-Cal managed care plans for calendar year 2022, phase 2 (July 1, 2022 – Dec. 31, 2022 service dates). These data will be what the final calendar year, phase 2 payments will be based on, so it is important that hospitals work closely with their contracted Medi-Cal managed care plans to ensure accurate utilization is being captured and reported to DHCS.
