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Current Information on Preferred Provider Status

“Preferred Provider Status” denotes an enrollment process in which the applicant must meet an additional set of statutory criteria, and if the statutory criteria are met, the applicant gets the benefit of expeditious enrollment.  Current statutory criteria for preferred providers recognizes only physicians as qualifying for preferred provider status and current law requires that physicians who qualify for “preferred status” be notified of their enrollment as such within 60 days of PED receiving the application package.  If a physician requests preferred provider status in an application, but fails to meet the additional statutory requirements for this preferred status, the application is processed according to the current statutory timeframe for all physician applications, which is 90 days from the date the PED receives the application.  Other than for the advantage of getting enrolled 30 days sooner than a ‘non-preferred’ application, there is no other advantage to the preferred designation.  Preferred providers are granted preferred provisional provider status for a period of 18 months, from the date of enrollment.   

Preferred Provider Status Background Information

“Preferred Provider Status” was first created in law commencing January 1, 2004. It was originally defined in Welfare and Institutions (W&I) Code Section 14043.26(c) and was subsequently implemented via regulatory bulletin by the Department of Health Services.  At the time it was first created, the statutory timeframe for enrollment as a preferred provider was 90 days.  This was a significant change, since at that time, all applications were statutorily permitted a 180-day timeframe for processing. 

With the implementation of Assembly Bill 1226 commencing July 1, 2008, the W&I Code subsection containing the language for preferred provider status was amended to appear in W&I Code Section 14043.26(d) and the statutory timeframe for enrollment as a preferred provider was reduced from 90 days to 60 days.  Assembly Bill 1226 also shortened the statutory timeframe for enrollment action on all physicians and physician group applications to 90 days.  So currently the only statutory enrollment action time difference between “preferred status” and regular status for physicians is 30 days.

Please see the regulatory provider bulletin“Medi-Cal Provider Enrollment Preferred Provider Status” for additional information. 

 

Last modified on: 7/3/2015 5:04 PM