The California Department of Health Care Services (DHCS) began receiving claims on July 1 for the newly established Code 19 rate. Similar to the Code 18 rate for Medi-Cal Managed Care services, Code 19 will be imbedded into the prospective payment system (PPS) rate for services provided by FQHCs and RHCs to beneficiaries of the Children’s Health Insurance Program(CHIP). The Code 19 rate equals the difference between what the clinic receives for Healthy Families services and their Medi-Cal PPS rate.
DHCS is requiring that clinics submit a request form to the Audits & Investigations department to establish an initial Code 19 rate. If you have not yet submitted the request form for payment, your rate will be automatically set at $1. Any amount due to your clinic above this payment will not be refunded to your clinic until after you submit your year-end PPS reconciliation forms, causing a delay in reimbursement.