Published: July 25, 2023
In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive reimbursement for services provided to Medi-Cal beneficiaries when it is not an enrolled provider. Second, it takes a long time to advance applications through the California Department of Health Care Services (“DHCS”) enrollment application review process (in some instances nine months or even longer), so re-filing can mean an extended period of no reimbursement. Third, a provider or other providers that are affiliated with the denied provider may have to disclose the denial, however innocuous, on enrollment applications in the Medicare and Medicaid programs forever. Failure to do so may itself cause additional denials in the future, so it is also important to keep track of the denial.