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PE4PW Applicants: Manual Enrollment and Paper Claims to be Discontinued

July 30, 2018

Effective October 31, 2018, the Department of Health Care Services (DHCS) is discontinuing the manual enrollment and paper claim processes for assisting individuals to apply for the Presumptive Eligibility for Pregnant Women (PE4PW) program.

PE4PW qualified providers (QPs) who assist individuals to apply should discontinue use of the paper MC 263, Application for Presumptive Eligibility for Pregnant Women Program, and shred old unused forms. Providers will use, instead, the electronic application through the PE4PW web Portal. A printable version (MC 263-P) to gather information from applicants prior to submission of the electronic application is available in English and Spanish in the Transactions area of the Medi-Cal website.

The transition period for existing providers and their staff to move from the manual (paper) process to the previously announced web Portal electronic enrollment process, expires on October 31, 2018.

Claims submitted with paper MC 263 PE Proof of Eligibility identification cards for dates of service on or after January 1, 2019, are not reimbursable. Claims submitted using the paper PE Proof of Eligibility card will only be valid for dates of service prior to January 1, 2019. For dates of service on or after January 1, 2019, claims with the PE Proof of Eligibility identification card will deny.

Qualified providers who are not using the electronic real-time enrollment process are encouraged to transition and minimize impact to their business operations. Requirements and changes for PE4PW are:

  • Current QPs of the program will have to complete the Qualified Provider Application and Agreement for the Presumptive Eligibility for Pregnant Women Program (MC 311) and go through Computer Based Training to continue participation in the program.
  • QPs must have a Medi-Cal Point of Service (POS) Network/Internet Agreement on file with the DHCS Fiscal Intermediary to access the online web portal.
  • To access the PE4PW application portal, providers must have a National Provider Identifier (NPI) and PIN to log into Transaction Services on the Medi-Cal web site.
  • Recipients will continue to apply for benefits in person at QPs’ offices.
  • QPs will use the online enrollment web portal for eligibility determinations.
  • Presumptive eligibility determinations will occur in real-time.

Questions concerning enrollment, computer based training and other Presumptive Eligibility for Pregnant Women issues can be sent to PE@dhcs.ca.gov.

Guidelines and instructions for enrolling applicants are available in the Presumptive Eligibility for Pregnant Women (PE4PW) Application Web Portal User Guide.

Providers are encouraged to watch for PE4PW updates in the NewsFlash area on the Medi-Cal website. Providers should also subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to PE4PW by completing the MCSS Subscriber Form on the Medi-Cal website.