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PE4PW: Paper Claim Submission Discontinued and Provider Manual Updates

October 4, 2018

Effective October 31, 2018, the Department of Health Care Services (DHCS) is discontinuing the manual (paper) enrollment process 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 use, instead, a printable version (MC 263-P) 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, will not be reimbursable.

QPs who are not using the electronic real-time enrollment process are encouraged to transition, including participating in required PE4PW computer based training (CBT).

PE4PW Provider Manual Sections Revised
Information about the old paper PE4PW enrollment methods has been removed from the Medi-Cal provider manual. PE4PW provider manual sections and checklist will be as follows:

Section Title Update(s)
Presumptive Eligibility for Pregnant Women Paper process information/forms and billing codes removed. Gender references adapted.
Presumptive Eligibility for Pregnant Women: Billing Codes New section
Presumptive Eligibility for Pregnant Women Program Process No updates
Presumptive Eligibility for Pregnant Women Provider Enrollment Instructions No updates
Presumptive Eligibility for Pregnant Women Provider Enrollment Checklist No updates

Computer Based Training Required
The PE4PW CBT available on the Medi-Cal Learning Portal (MLP) helps newly qualified providers use the automated Presumptive Eligibility for Pregnant Women Program Application (MC 263) to grant immediate, temporary Medi-Cal coverage for applicants who think they are pregnant, and who meet PE4PW program qualifications.

PE4PW participating providers must complete this training before access to the MC 263 is granted.

New MLP users must register to obtain a user account. During MLP registration, the user must select “Healthcare Provider” or “Provider Staff” as the type of user, and provide a National Provider Identifier (NPI) before taking the training.

Existing MLP users must verify their user profile upon log in to ensure the type of user is either “Healthcare Provider” or “Provider Staff” and ensure their NPI is associated with the user account. If the user profile has a type of user other than the two mentioned, the user must update the profile before taking the PE4PW training.

Providers who are not registered in MLP, using a valid NPI and under either Healthcare Provider or Provider Staff user types will not be able to see the link to the PE4PW training course in MLP.

Failure to update user profiles to include appropriate user types will delay providers’ access to the provider training, and their ability to help applicants apply for temporary Medi-Cal via the automated PE4PW application.

Accessing the Training
The computer must pass a connectivity test for providers to access the training. Providers should:

  • Visit the Medi-Cal Learning Portal.
  • Click the register link on the top right corner of the page.
  • Complete all required fields marked with red asterisk on the registration form.
    • Select User Type “Health Care Provider” or “Provider Staff.”
    • Enter a valid NPI. You will need to use the same NPI to enroll applicants in the Presumptive Eligibility for Pregnant Women (P4PW) website.
  • To complete the registration, enter in the Captcha, click the “Accept Terms” box, and click the “Register” button on the bottom right of the page.
  • Check your email for login credentials. You will be prompted to update your password after initial login.
  • After logging in, navigate to Training, then select “eLearning and CBTs.”
  • Click “Presumptive Eligibility for Pregnant Women (PE4PW) Program Provider Training Course” under Provider Training.
  • Take the training and complete the test with 80 percent or higher score.

Providers who are unsure what user type is associated with their account, or who know their user type needs to be changed, should contact the Telephone Service Center (TSC) at 1-800-541-5555 and select Option 4 and then Option 2. A TSC agent will verify whether information is correct and, if necessary, submit a request to update the user profile. User profiles should be updated within 48 hours. Once a profile is updated, the provider can complete the CBT.

Questions
Questions concerning enrollment, computer based training and other PE4PW issues can be sent to PE@dhcs.ca.gov.

Updated manual pages reflecting this policy will be released in a future Medi-Cal Update.