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Provider FAQs

 Provider Frequently Asked Questions

Application Package

Once I become Family PACT approved, do I need to keep any legal documents?

Yes, providers must maintain legible copies of all initial and updated applications and practitioner agreements at the provider site.

Do we need to notify Family PACT of any change of information?

Yes, Family PACT providers are required to inform OFP and DHCS Provider Enrollment Division (PED) of any changes to Service Site Address, NPI, Legal Name, and Business Name. These changes do not require the provider to attend the orientation.

For changes in Practitioner personnel (MDs, NPs, CNMs, PAs), providers are required to report changes to Medi-Cal and Family PACT within 35 days.

What happens if I fail to complete my online training modules and in-person orientation in 6 months? Can I reapply?

Failure to complete orientation within six months will result in disenrollment. A provider who has been previously disenrolled for this reason may re-enroll in the Family PACT Program but will not be granted provisional enrollment, and must complete all trainings before their application is approved for enrollment. (PPBI Provider Enrollment)

What happens if my application is deemed deficient?

Applicants are allowed 60 days from the notification date to resubmit a corrected application when it is returned deficient. If a Family PACT provider applicant and/or new provider location fails to resubmit the corrected application to the DHCS Office of Family Planning (OFP) within 60 days, or fails to remediate the deficiencies, the application will be denied. Applicants denied for failure to resubmit in a timely manner or for failure to remediate, may reapply at any time. (PPBI Provider Enrollment)

What happens after I submit my application?

Generally, it takes about 30 days for OFP to process the application once it is received and the provider is already enrolled in Medi-Cal. Once the application is approved by OFP, the provider will be sent the following:

  1. Family PACT Program Provider Agreement form (DHCS 4469)
  2. Family PACT Program Practitioner Participation Agreement form (DHCS 4470) if applicable.

For questions regarding Family PACT provider application packets, please contact ProviderServices@dhcs.ca.gov

Enrollment

How do I know if my enrollment has been approved?

If a provider is already enrolled in Medi-Cal when the provider submits a Family PACT application, then after the Family PACT application is approved and all provider enrollment requirements set forth in this section have been met, that provider’s Family PACT enrollment effective date will be made retroactive to the date DHCS received the provider’s Family PACT application.

Upon approval, providers will receive written confirmation of enrollment, including the enrollment effective date. (PPBI Provider Enrollment)

Who is eligible to enroll in the Family PACT Program?

Solo providers, group providers or primary care clinics, who currently have a National Provider Identifier (NPI), are enrolled in good standing with Medi-Cal, and have the family planning skills, competency and knowledge to provide comprehensive family planning are eligible to apply for enrollment into the Family Planning, Access, Care, and Treatment (Family PACT) Program. Providers must be able to provide the full range of services covered in the Program. (PPBI Provider Enrollment pg. 1)

What do I do if I want to enroll an Intermittent Clinic or a mobile clinic?

Intermittent clinics, as defined by Health and Safety Code (H&S Code), Section 1206(h) and mobile clinics, as defined by H&S Code, Sections 1765.120, 1765.150 and 1765.155, must apply for enrollment in the Family PACT Program using their organizational NPI. The organizational NPI must be enrolled in Medi-Cal in good standing.

Can the same site certifier certify multiple sites?

The site certifier cannot certify multiple sites. Each service location must designate one eligible representative to be the site certifier. (PPBI Provider Enrollment)

For questions regarding Family PACT provider enrollment and recertification, please contact ProviderServices@dhcs.ca.gov

Provisional Enrollment

What is a Provisional Enrollment Period (PEP)? How long is the PEP?

New Family PACT provider applicants and/or new provider locations will be provisionally certified for enrollment in the Family PACT Program until an eligible representative completes a legislatively mandated Provider Orientation as determined by DHCS.

Provider Orientation must be completed within six months of the date of initial Family PACT enrollment for the provisional certification to be lifted. (PPBI Provider Enrollment)

Recertifying Family PACT provider applicants will be provisionally recertified for enrollment in the Family PACT Program.

 

For questions regarding Family PACT provider provisional enrollment, please contact ProviderServices@dhcs.ca.gov

Site Certifiers

Does the person who completes the Online Provider Orientation Training Module have to be the same person who attends the In-Person Training Provider Orientation?

Yes, the site certifier must be the same person who completes the online training and attends the In-Person Provider Orientation. Upon completion, a certificate for each training will be provided as proof of participation.

Can the person who is the site certifier attend the In-Person Provider Orientation Training and complete the online training modules if he/she is pending Medi-Cal approval?

Yes, however this is considered for educational purposes, and a certificate will not be provided if the application is not complete and approved.

Who is eligible to be a site certifier?

  • The Medical Director, Physician, Certified Nurse Practitioner, or Certified Nurse Midwife, who is responsible for overseeing the family planning services rendered at the location to be enrolled, is eligible to certify the site.
  • Each provider’s service location is required to be certified for enrollment in the Family PACT Program. Applicants who are enrolled in Medi-Cal and in good standing and who have submitted a Family PACT application packet may complete the Provider Orientation to certify a site for enrollment.
  • Site certifiers must complete the online orientation training and attend the in-person training. The site certifier must ensure that all clinical personnel rendering services on behalf of the Family PACT Program complete OFP required training.
  • Site certifiers are required to present photo identification during registration for the in-person training and shall attest to a statement affirming responsibility. (PPBI Provider Enrollment)

For questions regarding Family PACT Site Certifiers, please contact OFPprovidertrainings@dhcs.ca.gov

Disenrollment/Deactivation

Can I voluntarily disenroll from the Family PACT Program?

Providers may terminate their participation in the Family PACT Program at any time by providing written notification of voluntary termination to Family PACT Provider Enrollment. The letter should be on provider or clinic letterhead and must include:

  • NPI number
  • Service site address
  • Effective date of disenrollment: Last day of operation
  • Provider-owner’s signature. (PPBI Provider Enrollment )

Letters should be mailed to:

Department of Health Care Services
Office of Family Planning
Family PACT Provider Enrollment
P.O Box 997413, MS 8400
Sacramento, CA 95899-7413

Providers are responsible to ensure unused HAP cards are returned to the Fiscal Intermediary (FI) at the time of disenrollment from Family PACT. Unused HAP cards must be packaged with a cover letter, including the provider number or NPI used to order the cards, and returned to UPS of a similar service to the FI at:

Conduent
Attn: Print and Distribution Center
830 Stillwater Road
West Sacramento, CA 95605

For questions regarding provider disenrollment and deactivation, please contact OFPcompliance@dhcs.ca.gov

HAP Cards

How do I order and activate HAP Cards?

HAP Cards can be ordered by calling the Telephone Service Center at 800-541-5555. Please ensure to have site information when ordering HAP Cards. HAP card issuance and activation must occur exclusively at the service site (enrolled address) represented by the enrolled Family PACT provider National Provider Identifier (NPI) to whom the sequential cards were distributed.

Family PACT providers must issue and activate a HAP card at the time a client is enrolled. Activation must be on the date of service for new clients. Providers who neglect to activate a card upon certification of a client are responsible for covered services rendered. Pharmacy, laboratory or clinical providers to whom the client is referred will not be able to receive reimbursement until the HAP card is activated. Clients must not be charged for Family PACT services after certification is complete.

There are two types of eligibility transaction methods to activate a HAP card: the Automated Eligibility Verification System (AEVS) and the Medi-Cal website.

For questions regarding Family PACT HAP cards, please contact the Telephone Service Center at 1-800-541-5555

Billing

If I experience problems with billing or claims who should I contact?

Providers may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers may be directed to a particular specialty unit for assistance.

TSC is the first line of communication between providers and the California MMIS Fiscal Intermediary. The TSC is staffed by knowledgeable telephone operators who can help providers understand the following:

Unclear provider manual information
Medi-Cal billing policies and procedures

For questions regarding Family PACT billing, please contact the Telephone Service Center at 1-800-541-5555