PCPs are providers who are enrolled through one of the Regional Contractors (RC) and have a Primary Care Provider Enrollment Agreement (PCPEA) on file with CDS. Some PCPs only enroll for Breast Cancer Screening services, while other enrolled PCPs conduct breast and cervical cancer screening services. PCPs perform clinical breast exams (CBE) and/or pelvic exams/Pap tests and coordinate recipients’ care. PCPs are the screening entry point for recipients and are the only providers who can enroll recipients through the Enroll Recipient and Recipient Information online forms and complete and submit the Breast and/or Cervical Cancer Screening Cycle forms. Each PCP must complete a Medi-Cal Point of Service (POS) Network/Internet Agreement and have Internet access to participate in this program. Reporting the final outcome for each recipient of the screening and diagnostic service provided is very important for future program funding.
PCPs are required to inform the referral providers of the billing requirements, covered services, recipient’s eligibility status and the 14-digit recipient identification (ID) number. PCPs remain responsible for ensuring that clinical standards of the program are met. PCPs are responsible for obtaining and submitting data (e.g., diagnostic procedures, final diagnosis and treatment status) from referral providers.
Referral providers are any providers to whom PCPs refer CDP: EWC patients, including radiologists, surgeons, anesthesiologists and pathologists. PCPs can refer recipients to any appropriate Medi-Cal provider in good standing.
Referral providers must comply with the following:
As part of ongoing quality improvement, PCPs are responsible for reporting screening and outcome data within 10 days of receiving final results. This time frame is preferable and recommended. However, PCPs may enter data for 365 days after a recipient’s certification period ends. PCPs are also able to enter data for services that have occurred 180 days prior to the recipient’s enrollment into CDP: EWC.