Provider Eligibility

Provider Eligibility

Thank you for your interest in becoming a Family PACT Provider, the network of providers meeting the comprehensive family planning needs of California residents. To be eligible to enroll in the Family PACT Program, licensed medical providers must have:

  • A National Provider Identifier (NPI)
  • Be enrolled and be in good standing with Medi-Cal
  • The ability to provide comprehensive family planning and reproductive health services, and provide the full range of services covered in the program

Non-Physician Medical Practitioners

 

Non-Physician Medical Practitioners (NMPs) employed by a Medi-Cal provider who is applying to enroll in the Family PACT Program and who will be delivering Family PACT services must be identified on the Application to Participate in the Family PACT Program (DHCS 4468) and complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470). NMPs eligible to participate in the Family PACT Program include Nurse Practitioners (NPs), Physician Assistants (PAs) and Certified Nurse Midwives (CNMs). Definitions for NMPs are located in the Non-Physician Medical Practitioners (NMP) section in the appropriate Part 2 Medi-Cal provider manual. Unless otherwise stated, the Family PACT Program defers to Medi-Cal policies, billing instructions and reimbursement for NMPs who deliver Family PACT services.

NMPs are authorized to deliver the full scope of Family PACT family planning and family planning-related services, with the exception of male and female sterilization, within their scope of practice and to the extent permitted by applicable professional licensing statutes and regulations as set forth in the physician/practitioner interface document.

Providers Not Required to Enroll

 

Anesthesiologists, laboratories, pharmacies and radiologists who are enrolled as Medi-Cal providers are not required to enroll in the Family PACT Program.

Ordering, Referring, or Prescribing (ORP) Providers

 

W&I Code, Section 14043.1(b) and (o) require the enrollment of ORP providers as participating providers in the Medi-Cal program. W&I Code, Section 14043.15(b)(3) provides that the NPI of the ORP provider must be listed on all claims for reimbursement.

There are three basic requirements for ORP providers:

  • The ORP provider must be enrolled in Medi-Cal
  • The ORP provider’s enrolled NPI (Type 1) must be for an individual (not an organizational NPI)
  • The ORP provider must be eligible to order, refer and/or prescribe in accordance with law and the health care practitioner’s practice act

If an ORP provider identified on a Family PACT claim is not enrolled in Medi-Cal, the claim for reimbursement of the goods or services they provided in filling a client’s order, referral or prescription will be denied.

Additional information on ORP providers is available on the DHCS Medi-Cal website.