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Provider-Preventable Conditions

The Department of Health Care Services (DHCS) is now accepting online reporting of provider preventable conditions (PPCs). Welfare and Institutions Code Section 14131.11 and Title 42 of the Code of Federal regulations, Section 447, 434, and 438 require that all Medi-Cal providers report PPCs that are associated with claims for Medi-Cal payment or with courses of treatment prescribed to a Medi-Cal recipient for which payment would otherwise be available.

Reporting is mandatory under federal and state law. A provider must report the occurrence of any PPC in any Medi-Cal recipient that did not exist prior to the provider initiating treatment. A provider must report the occurrence regardless of whether or not the provider seeks Medi-Cal reimbursement for services to treat the PPC.

A provider reports a PPC by using the Provider Preventable Conditions Reporting page, a secure online reporting portal. Providers must submit the electronic report after discovering the condition and confirming that the recipient is a Medi-Cal beneficiary. Reporting a PPC for a Medi-Cal beneficiary does not preclude the reporting of adverse events and healthcare associated infections to the California Department of Public Health (CDPH), pursuant to Health and Safety Code (H&S Code) Sections 1279.1 and 1288.55.

The documents available on this page are updated on an ongoing basis to ensure that they contain the most up-to-date information. Providers and submitters are encouraged to bookmark this page and refer to it often for the most current documents.

Frequently Asked Questions (FAQs)

Articles

Reporting Requirements

DHCS link



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