Enrolling with Medi-Cal as a practice. The state file comes before every plan.

A California practice enrolls in Medi-Cal through PAVE, the online enrollment portal run by the Department of Health Care Services. A group files its own application, and each clinician files a rendering application affiliated to it. Medi-Cal managed care plans must confirm that enrollment before they contract, so the state file comes first and each plan's credentialing follows it.^A

Who files what.

Medi-Cal enrolls people and practices by provider type. PAVE lists physicians, nurse practitioners, optometrists, chiropractors, therapists and dentists among its individual types, with a matching group type for most of them.^B A solo clinician enrolls as an individual provider.

A group is a different application with a firm floor. To enroll as a group, at least two enrolled rendering providers must be affiliated with it. Every other clinician who treats patients for the group affiliates through PAVE as well.^A The group application does not carry its clinicians. Each one needs an enrollment of their own, tied to the group.

The order we file in.

1. Fix the NPI record first.

Every clinician has an individual National Provider Identifier, and the practice has one of its own. Both live in NPPES, the national register CMS keeps.^C Medi-Cal plans check NPPES when they screen a clinician and keep checking it after.^A A stale address or the wrong specialty there becomes a question on the Medi-Cal file. We correct it before anything is filed.

2. List every place you see patients.

Medi-Cal enrollment is tied to a location. Each practice location has to appear on the application, and each must meet the state's place-of-business rules. The exceptions are narrow, mostly clinicians who work inside licensed facilities.^A A second office opened later is its own filing.

3. File the group, then each clinician, in PAVE.

PAVE collects what the state's paper forms once did: the provider application, a disclosure statement and the provider agreement.^A We prepare the group file and each rendering application together, so the affiliations line up the day they are submitted.

4. Expect screening by risk level.

Every applicant is screened as limited, moderate or high risk. Moderate and high risk bring a site visit. High risk also brings fingerprints and a background check, for the provider and for anyone holding five percent or more of the ownership.^{A, D} Enrolled practices can also receive unannounced inspections at any location.

5. Credential with each plan.

Medi-Cal managed care plans come next. A clinician enrolled through the state program is eligible to contract with those plans, and each plan still credentials the clinician on its own terms. Enrollment and credentialing are separate steps.^A A clinician enrolled only to join a plan's network does not have to see fee-for-service patients.

What sets the timing.

State law gives the department a set window to act on an application filed directly with it. A file that is returned for correction, or referred for review, can run past that window, and plan network clinicians get no faster lane through the state program.^A So the pace is set by three things we can influence: how complete the first submission is, how fast each correction goes back, and whether a site visit is scheduled promptly.

A plan may let a clinician see its members for a limited period while screening is still pending. If enrollment is denied, or is not finished when that period ends, the clinician has to leave the network. Resubmitting does not buy more time; the plan can only contract again once enrollment succeeds.^A

What trips practices up.

A clinician who leaves a group to practice alone needs a new individual enrollment. The group's enrollment does not travel with them.^A

The wrong person holds the PAVE profile. Denial letters and requests arrive as messages inside PAVE, visible only to the people on the applicant's account profile.^A When that is a former office manager, a correction request can sit unread. We confirm who is on the profile before we file.

A clinician who orders or refers but never bills still has to enroll. Federal rules require ordering and referring clinicians to enroll, or the provider who bills on their order is not paid.^D

A new location goes unreported. Enrollment is tied to each location, and the plans reconcile their networks against the state's enrolled list every month.^A

How we run it.

We clean the NPI records, build the PAVE group and rendering files together, answer each correction request, and then take the file to the Medi-Cal plans your patients carry. Each application is tracked to an effective date, and our prices are printed per application. If we run your billing, the first Medi-Cal claims go out under that date and we follow each one to payment.

Questions practices ask.