CMA Encourages New Medi-Cal Physicians
to Seek Preferred Provider Status
[Posted 12/23/04]

The California Department of Health Services (DHS) this year updated its Medi-Cal provider enrollment regulations to allow provider applications to be expedited if the physician meets certain pre-approval criteria. Physicians who meet these criteria can seek “preferred provisional provider” status and have their applications processed within 90 days. The current time frame for approval of standard provider applications is 180 days.

“The backlog of provider applications awaiting approval has been a constant source of complaint from many physicians who have experienced delays of many months and in some cases approaching a year,” said CMA Vice President of Economic Services Nileen Verbeten. “CMA will continue to work with DHS over the next year to improve the provider application process, but in the meantime we urge qualifying physicians to go the preferred provider route.”

To enroll as a preferred provisional provider you must either be credentialed by a Knox-Keene-licensed health plan, be a member in good standing of a medical group credentialed by such a plan, be credentialed by a county organized health system, or be a current faculty member of a JCAHO-accredited teaching hospital or children’s hospital.

The preferred provider application package must include a cover letter declaring under penalty of perjury that you have a current, unrestricted license to practice medicine in California, have full privileges at a JCAHO-accredited acute care hospital, and have no “adverse entries” in the U.S. Department of Health & Human Services’ National Practitioner Data Bank.

For detailed instructions on submitting a preferred provisional provider application, click here.

Contact: CMA’s reimbursement help line, 888/401-5911.