​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​DHCS Data Reporting and Monitoring Webinar Series Frequently Asked Questions

1. We have been reporting mental health on our medical 274, including the flags for mental health areas of expertise. Are these going to be on a separate file now? 
   MCPs will continue submitting 274 files according to instructions in the 274 MCP Companion Guide. The Mental Health data referenced in the (CG) is related to mental health services offered by the MCP not the counties.  This includes the following two data elements:
   

• B.9 Mental Health Provider Area of Expertise Codes (2100EA N202)
  
• B.10 Mental Health Provider Practice Focus Codes (2100EA N202)​
  

2. ​Will there be new or revised 274 companion guide updates in the near future with regard to new APLs specific to new provider types such as Doula's and changes surrounding Nurse Practitioners who meet criteria for no longer requiring physician supervision and any other anticipated changes? 
   ​Companion Guide updates are made whenever new APLs and other changes require an update. When changes to Medicaid policy or HIPAA related regulations require changes in the way data is reported on an existing transaction, (such as the 274), the associated Companion Guide(s) will be updated to reflect those changes.
   

3. Does this new organization include oversight of Medi-Cal FFS data?  If so, what are the plans / timelines to move away from California’s local codes.  These codes continue to cause challenges within the Managed Care space? 
   This includes oversight of FFS data, however, the Provider Manual and other guidance found at the Medi-Cal site are not intended to provide coding or billing guidance to providers that are contracted to MCPs, or who submit claims to MCPs. Providers that are submitting FFS style claims to MCPs for payment are still​ required to use HIPAA Compliant, National Codes. Local codes are not allowed.
   

4. Sorry for repetition, but just to confirm MCPs will NOT need to submit a new, separate 274 for MH and will submit only a single 274 including both medical and MH providers? 
   ​County behavioral health services data are submitted separately by the counties, not the MCPs.
   

5. What is the most current version of the 274 companion guide?
   The most current version of the Medical/Physical 274 Provider Information companion guide is v. 2.2.
   The most current version of the Mental Health Companion Guide (CG) is v.1.7 (Please note, a new Behavioral Health CG will be published that includes both the Mental Health CG and the DMC-ODS CG. Version number and draft will be shared soon, TBD).​
   

6. When will be new 274 companion guide published? Like the information regarding some NP can practice without supervising physicians in the future, need update guidance how to report those NP on 274 without supervising physicians. 

   Typically, Companion Guides (CGs) are first published in DRAFT form and distributed to plans for review and input. Once that cycle has completed, the Final form of the CG is published to the DHCS Documentation Center (DDC).

   ​The companion guide for the Behavioral Health provider information transaction is being updated to include both Mental Health and DMC-ODS guidance. A DRAFT is in current review and will be shared with trading partner stakeholders for review within the next week or two.
   

7. Please confirm if QMED v2 still in the works? / Not 274 related, but Encounter data related.  Can we get an update on the status of QMED v2? 
   ​Yes, QMED v2 is still in the works.
   

8. Can you elaborate on "rectifying all warning messages"? So far, we did not have to do that. 
   ​Plans are required to address the warning messages and resubmit the file in case of any data discrepancy in the JSON file. If the plans do not identify any data issues in the specific metric, plans are required to just notify DHCS through email about the reason for the warning message.
   

9. Do we have to respond to the email even when plans have passed all the MDC data metrics?​
   ​Yes, we expect a response to the email, even if it's just an acknowledgement of receipt.
   

10. Can you let us know if e-consult only providers (who only communicate with other providers and not members) need to be included in the 274? 
    It will be updated as soon as we have a corresponding answer. Thank you for your patience.
    

11. Last month's 274 MDC covered periods prior to the most recent reporting month. Please advise if DHCS has changed from monthly reporting to cover earlier reporting periods.
    274 MDC reports cover data from the previous month, prior to the month of submission.
    

12. Can you please define QIMR? What is the go-live date for QIMR?
    QMIR is Quarterly Implementation Monitoring Report and QIMR is planned to "go live" during second half of 2024.
    

13. Current QIMR report (EXCEL) will be discontinued from Jan 2024?
    No. QIMR Excel report continues until all elements of the Excel report are converted to JSON format. 
    

14. 274 files are submitted by health plans, not by health services centers? 
    This is correct, 274 files are submitted to DHCS by the Medical, Dental and Behavioral Health managed care plans that are contracted to DHCS. 
    

15. Do 274 or PNR files include quality data, for example fluoride application %? 
    The 274 and PNR files only include provider network data, no utilization data.
    

16. What depts are sending out the QMED reports?
    The Data Quality Reporting Unit sends out the QMED Reports to Managed Care Plans on a quarterly basis.

17. Are PACE programs expected to be receiving these?
    PACE Plans/Organizations will be receiving QMED as part of the QMED 2.0 PACE. Programs that are currently not receiving these will in the future.  

18. Are PACE plans expected to submit the 274s?
    PACE plans are not currently submitting the 274 transactions. More will be shared regarding that data collection. Specifically, Dental currently only receives/oversees 274 files from our DMC plans (excluding PACE). 
    

1. For the Primary Care Physician Assignment (PCPA) file, is reporting for FQHCs done at the site level and not to a PCP?​ 
   The PCPA file uses data elements to report Primary Care Physician Assignments. Reporting is done at the provider level. There is no site level data element. 
   

2. We had proposed a list of potential new grievance types and benefit types to add to the existing list of grievance types currently in MCPD schema v3.02. We believe that these are distinct from existing grievance types and will help us to more accurately characterize our grievances and to improve the quality of our grievance reporting. When can we expect that these will be approved and available to use? 
   ​​​Grievances are being discussed and an update on the suggested new types will be shared soon.
   

3. Warnings in the MCPD and PCPA response files usually relate to membership issues which usually get sorted by the next submission. Under what circumstances would a plan need to resubmit the MCPD and PCPA data files with regards to Warning messages?
   During business edit validation, there may be instances where a warning message will be identified. Warning messages will not cause a file rejection and are intended as informational to the submitter identifying potential future issues that may become fully fledged errors in the future. DHCS asks that MCPs correct warnings and resubmit the file.
   

4. What is the Production Go-Live Date for these changes? Could DHCS please provide clarification on the PCPA Production Go-Live scheduled for 01/01/2025?
   The date will be announced shortly. The Test Environment will be available by 01/01/2025, with the Production Environment going live by 02/01/2025, which will include reporting for January ​data.
   

5. When will the SCHEMA docum​ent be released so that Plans can test and validate against it?
   The schema document will be released and available in the DHCS Doc Center following the distribution of the Final Technical Guide communication.
   

6. For PCPA testing, should we continue using only test CINs?
   Yes, Plans should exclusively use test CINs when submitting test files. Test CINs are designed to ensure that files pass enrollment/eligibility validation. Any errors encountered with test CINs in a test file can be disregarded. However, if a test file fails to process due to a test CIN error, please reach out to DHCS for assistance.

7. Can DHCS provide clarification on the PCPA go-live date of 01/01/2025?
   Plans should begin submitting test files starting on 01/01/2025, as the test environment will be available at that time.

8. What is the expected production go-live date, and what are the differences between the current version and the final version of the Technical Guide?​
   The production go-live date is scheduled for 02/01/2025. The current DRAFT version of the Technical Guide is considered the FINAL DRAFT, with no further changes anticipated to the PCPA layout or schema. The PCPA Technical Guide was previously part of a combined MCPD/PCPA guide; it has now been separated. The FINAL DRAFT version includes additional elements to the PCPA schema, which are outlined in the latest version of the guide.
   

9. ​Are PCPA vs 274 comparisons conducted at the practitioner or site level, or both?
   The DHCS Data Science Branch, in collaboration with DHCS program areas (MCOD, MCQMD, QPHM), conducts analysis of submitted provider data. For further information, please contact your designated program area liaison.​

1. Does 274 go into PACES?
   Yes. All 274 files submitted to DHCS are processed by PACES.
   

2. What are the Health Care code sets? 
   Health Care code sets refers to those code sets (HCPCS, etc. that are required on X12 EDI and other transactions. Most code sets used on the 837 transactions are listed in an appendix found in the X12 5010 837 Implementation Guides.
   

3. We frequently see encounter data denial reasons which state "Only codes specified in code list 130 are allowed."  Is code list 130 publicly available? 
   Each X12 Implementation Guide publishes a list of Code lists referenced in the Guide or required in the transaction. Code List 130 is listed in Appendix A of the 837 Implementation Guides, which are available from X12.
   

   • Code list 130 - Healthcare Common Procedural ​Coding System (HCPCS)

   • AVAILABLE FROM: 
     ​Centers for Medicare & Medicaid Services
     7500 Security Boulevard
     Baltimore, MD 21244​ ​​

4. ​Can we get guidance on the filtering used for the FQHC volumes so we can attempt to replicate for comparisons?
   Guidance has been disseminated to the associations and FQHC APM applicants. If you would like a copy, please reach out to the FQHCAPM@dhcs.ca.gov mailbox. 
   

5. ​Where can we find the current Companion Guides for the EDI transactions?

   Managed Care Encounter Companion Guides are posted to the DHCS Documentation Center, which is accessible to all DHCS Trading Partners upon request. Please send access requests to dataexchange@dhcs.ca.gov. Guides are available under different channels within the DHCS Documentation Center. 
   

6. Is there a metadata/data dictionary we can be provided to use in hand with the 274 Companion Guide? 
   No. All business rules are identified in the 274 Companion Guide and the associated X12 274x109 Implementation Guide, available from X12. 
   

7. The claims data is now due 10 days after the COM? 
   ​No, it is not. The PACES system processes encounter data and provider network adequacy data. Encounter data should be submitted as soon as possible after the encounter, but there is no due date. Provider Network Adequacy data submissions reflect the status of any plan’s provider network within a given month. For this reason, Provider Network Adequacy data is expected to be submitted via the X12 274 transaction by the 10^th of each month. 
   

8. What is the URL for "Documentation Center"?
   ​Here is the launch page for the documentation center.  https://teams.microsoft.com/l/team/19%3aMTndJi9glI7WQS1AhqVyLh3AeBMf8syywgxG8KQ1Loo1%40thread.tacv2/conversations?groupId=3862053f-5e17-47be-9fd8-5bbe497e593a&tenantId=265c2dcd-2a6e-43aa-b2e8-26421a8c8526 ​
   

9. Is there limit on Number of staff members who can get access to DHCS Documentation Center (DDC)?
   ​There is no current limit on the amount of trading partner staff who can be granted access to the DHCS Documentation Center (DDC). If the number of accounts with access goes over the maximum upper limit of teams, the Department will consider a limit.​
   

10. We have been given Test CIN's in the past by DHCS. Should we continue to use the Test CIN's for testing Encounter data?
    Yes, please use Test CINs if you have them. Test CINs are now posted to the DHCS Documentation Center. To clarify, DHCS will be providing Test CINs to all Managed Care and PACE plans at this time. We will also share information regarding Test CINs with BHPs when the time comes for BHPs to use them. For now, BHPs do not need to be concerned with Test CINs.  If you find the Documentation Center does not have Test CINs for your plan, or if the Test CINs result in eligibility errors in your test files, please contact your Encounter Data Specialist.​

11. What does BHP stand for?
    BHP stands for Behavioral Health Plans. California counties provide Behavioral Health services to Medicaid members. Services are administered by county based organizations, which are referred to as BHPs.
    

12. What is the latest version of 837 I and P? 
    The latest version of the HIPAA mandated 837 is 5010. Please see x12.org​ for further information.
    

13. Are there plans to allow the use of real CINs for MCPs to use in the Test environment?
    No. Using actual CINs outside the production environment introduces some security and other PHI related concerns. Test CINs are provided in order to minimize the risk of a PHI breech.
    

14. Will the EVRs be in X12 format?
    EVR's are in .xml format, but follow the schema of the 837. In other words, the EVR lists errors and warnings in the same order that the data elements are in within the 837 transaction structure. The .xml format will not change.​
    

15. As a Third Party Submitter for a number of plans, are there instructions for who we need to contact in order to add new Plans to an already existing submitter?
    All third-party submitters for current Healthy Care Plans need to go through the Health Care Plan to discuss the access needs for submitting files to DHCS PACES SFTP site. For example, if a Health Care Plan is using (or will be using) EDIFECS to create and submit the encounter data files, EDIFECS would need to have the Health Care Plan contact the DHCS Contract Manager to request adding EDIFECS staff onto the health care plan’s DHCS PACES SFTP access list. The information that the Contract Manager would require includes the: Edifecs staff name, title, phone number, e-mail, folder access (such as whether to both Test and Production servers), and folder access type (read/write/delete). Additionally, if the third-party is wanting to establish automated file upload to DHCS PACES SFTP, this will require an additional verification process and set up of a “special service account”. Please e-mail DataExchange@dhcs.ca.gov and the Health Care Plan’s Contract Manager to inquire about this type of set-up.
    

16. What is the average testing timeframe?
    

    ​The testing timeframe varies depending on the Health Care Plan undergoing testing. The largest driver of increasing the testing timeframe is whether the Health Care Plan is new to Medi-Cal and whether staff have experience working with Medi-Cal 837 and NCPDP files. The DHCS Data Quality team will work with the Health Care Plan to ensure the validation testing is successful and within a reasonable timeframe. 

    If the Health Care Plan is experienced in submitting encounter files mentioned above, the testing timeframe can last as little as 1 month or less. If the Health Care Plan is using a well-established third-party vendor to submit Medi-Cal encounter files, the testing timeframe may be further abbreviated as long as submitted files adhere to the Testing Criteria. 
    

17. Where do I get the test CINs from?
    The Test CINs for LA Care are available in the DHCS Documentation Center. To ensure that you have access to that site, and are able to download the Test CINs for LA Care, please send an email to DataExchange@dhcs.ca.gov
    

18. Since LTC is new to us and I don't think we ever received a LTC claim, does DHCS provides how a LTC claim/ encounter looks like? 
    LTC encounter data uses the 837 transaction standard, in the same way that "regular" medical claims/encounters use the 837 standard. Any variations are outlined in the 837 Companion Guides. 
    

19. We don't know what bill type and service code are considered as LTC, would you be able to guide me to the LTC billing? We have never encountered LTC claims or this is the same as SNF?
    Yes, further details regarding bill types/service codes will be shared soon. 
    

20. Does this testing apply to PACE plan?
    Yes, testing applies to PACE Organizations/Plans as well. PACE Plans that submit encounter data for Institutional, Professional (837 I/P files) are the same types of files submitted by Managed Care Plans. Some PACE Plans also may have dental encounters (837D) and would also undergo testing for submitting these types of files. 
    

21. For PACE programs currently reporting the same Encounter data to DHCS directly as they do to Medicare. Is the intent to send the same encounter data already reported to DHCS/Medicare, in this new process to the state from the data already submitted to Medicare? as it would seem duplicative to data already submitted to DHCS. Or is the intent to only report data not already reported to DHCS, as would be the case for Medicare only pts. Going forward is the intent to have PACE programs continue to report duplicative encounter data in two separate processes to the state? Or can we expect this to be a time limited process. 
    

    PACE Plans that have not gone through a testing process for 837I, 837P, 837D, or NCPDP files and expect to have these types of encounters will need to go through the testing process. If a PACE plan has already gone through testing will not need to go through testing again, unless the PO undergoes a significant data systems change as discussed in the webinar. 
    

    The DHCS PACES SFTP Test server mirrors DHCS PACES SFTP Production so that if Plans would like to "check" the file that will be submitted to Production by submitting to the Test server. The response files produced by the Test server are the same as Production.

    If the question is regarding duplicate encounters that are submitted in 837 files to DHCS PACES SFTP, duplicate encounters at the service line need to be corrected. The number of existing duplicate encounters is a known data quality issue that DHCS is focused on improving and a goal for the Encounter Data Quality Improvement Project. 

    If the question is asking whether the PO needs to submit only one encounter file to Medicare (if beneficiary is enrolled) and does not need to submit that encounter file to DHCS PACES SFTP, that is incorrect. CMS performs and audit of DHCS data and it is important for DHCS to receive the same information the PO is reporting. I would refer to look at this website - Resource Material and Templates (ca.gov)​ and https://www.dhcs.ca.gov/provgovpart/Pages/PACE.aspx
    

22. Did notice the schema change for MDCPD (ECM). Is the schema changing for PCPA? 
    Any upcoming or potential changes in the schema will be first shared with Health Care Plans and our Plan Partners to review and provide feedback. DHCS communicated with Plan Partners in April 2024 the proposed changes to the MCPD/PCPA Technical Guide to add additional Benefit Types to section 2.1.4. You may find the current MCPD/PCPA Technical Document at the DHCS Docs center here: MCPD, PCPA Documents and Schemas
    

23. In the past DHCS had certain testing periods (Jan-March, June-August I think). Is this still the case?
    We hope to return to testing schedules such as those listed above. Data Quality hopes to have testing June - August for upcoming PACE organizations expected to on-board in July 2024 a current HCPs that are undergoing a major system change. 
    

24. Is there a limit of PACES access credentials for different testing resources?
    The typical limit of technical staff that will be submitting files to DHCS PACES Test or Server is four contacts. If the HCP would like different contacts for access to Test server or Production, the HCP will just need to list that in an e-mail with the DHCS Contract Manager. In general, we suggest that organizations limit the number of SFTP accounts to 5, but that is negotiable if additional access is needed
    

25. Will DHCS send out an email to Plans regarding the PACES SFTP testing timeline?
    Yes, that will be done.

26.  Do plan need to correct and resubmit if the file was ACCEPTED w/WARNING(s)? by the 10th also?
    Yes, you may resubmit correction files after the initial submission.

27. We will be receiving an updated documentation guide when CCM elements will be included, correct?
    Yes. Technical Documentation will be distributed and is also posted to the DHCS Documentation Center. For access to the Doc Center, please send a request to DataExchange@dhcs.ca.gov 

28. Are resubmissions to test environment included in semiannual report? Or only the ones resubmitted to work environment?
    Resubmissions to the test environment are not included in the Semi-Annual reports.

29. Will DHCS allow additional day(s) for testing considering will be releasing a new schema version when JSON Phase II is going live? We were told to use V2.0 in testing​
    Yes. An email will be going out with the schema and technical guide on August 1^st via EDIM mailbox with table of elements updated.

30. What process does the Plan need to take for the exemption process for a MDC failed category for the 274 file?
    Please refer to the APLs specific to 274 listed in the presentation. This is a policy questioned that should be directed towards MCQMD@dhcs.ca.gov as this division enforces contracts and monitors data quality. 
    

31.  From past experience, test environment does not always mirror production environment exactly. Close but not entirely.
    If you are referring to the PACES system, Production does mirror the Test/Staging environment. The standard procedure is to deploy updated code to the Test environment first, and 2 weeks later deploy to Production. We are not aware of any differences in environment. If you are detecting differences, please send an email to DataExchange@dhcs.ca.gov.
    There can be some issues with the CINs - additionally, the test server may also role out up-coming file schemas that allow Managed Care Plans time to adjust to the new schema. For example, the MCPD files in test server includes the additional benefit types that were communicated to Managed Care Plans in April 2024. Currently, the Prod server will not be accepting this "new" MCPD file until August 2024. I will refer to Data Exchange for the exact dates.
    Also, please let MCQMDProviderData@dhcs.ca.gov know if there are significant variances to the test server that impede your ability to use effectively. ​

32.  For more information on PACE?
    For PACE Organizations and policy, please refer to All Inclusive Care for the Elderly. You may also contact: PACECompliance@dhcs.ca.gov

33. ​Is it correct that the "Grievance Type" will no longer be required for Appeals?
    Yes, that is correct.

34. The "Grievance Type" is not removed from the Appeal record in the MCPD Technical Documentation (December 2024) under the description of changes. Can this be clarified?
    The changes are reflected in version 3.05 of the MCPD Technical Document, which was uploaded to the DHCS Documentation Center on January 24, 2025.

35. When will the new schema 3.05 go live in production, and when will testing begin?
    The submission deadline for MCPD files will remain the 10th of each month for the previous month's data. Testing will begin on February 1, 2025, and the production date is set for April 1, 2025. The first due date for submitting 3.05 version MCPD files will be April 10, 2025, for March 2025 data. The PACES team will deploy the updated MCPD code to Testing on February 1, 2025, and to Production on April 1, 2025. After April 1, 2025, all MCPD production data must be submitted by April 10, 2025. This 10th of the month deadline applies to all production data submitted on the MCPD file.

36. The "Denial of Payment Request" is one of our top Grievance Types. It appears to have been removed, but there don't seem to be any billing-related options added as a Grievance Type. Can you provide clarification?
    Per the federal definition, this should now be reported as an appeal rather than as a grievance.

    Changes to MCPD Data Elements:

    • Updates and additions have been made to the existing 3.05 MCPD Data Element Dictionary, including:
    • Updated Appeal Type 7 values (A1 to A7).
    • Added Appeal Reason.
    • Removed 9 values from Grievance Type.
    • Grievance Types removed:
    • Plan's Reduction / Suspension / Termination of Previously Authorized Service
    • Rural Member Denied Out of Network Request
    • Continuity Of Care
    • Denial of Payment Request
    • Denial of Request to Dispute Financial Liability LTC (Long-Term Care)
    • Timely Access LTC (Long-Term Care) Transportation
    • LTC (Long-Term Care) - Facility/Provider Grievances
    • LTC (Long-Term Care) - Other
    • Added a value for "Continuity Of Care (Providers)" under Grievance Type.
    • New values for "Continuity Of Care (Covered Services)", "Transplants", and "Gender Affirming Care" under Benefit Type.
    • Schema has been updated to version 3.05.

    Updates also include revisions to the MCPD Record Layout (Section 2.2), MCPD Response Files (Section 3), Example MCPD Files (Section 4), and MCPD JSON Files (Section 4.2).

    If you are still unable to find the Grievance Type field removed from the Appeal record, please ensure you are referencing the most recent version of the MCPD documentation.

    
    

37. In the MCPD Technical Document Draft V3.05, it is stated that the Grievance Type "Continuity of Care" will change to "Continuity of Care (Providers)," but this change was not listed in the slide for Grievance Type Changes. Will this change still take effect?
    
    Yes, this change is still scheduled to take effect in version 3.05. Please note that not all changes were included in the slides.

38. What is the maximum number of test CINs that can be used?
    The maximum number of Test CINs that DHCS can issue at this time is limited to five (5). In some instances, Test CINs can be reused, but there is a risk that the system may treat them as duplicates, which could lead to file rejection during testing.

    Due to the limited availability of Test CINs, DHCS recommends that trading partners consider using "dummy" Test CINs. These "dummy" Test CINs must follow the Test CIN formatting rules: eight (8) numeric characters followed by one (1) alpha character, such as "A". While the use of "dummy" Test CINs will result in warnings, no file rejections will occur, and these warnings can be disregarded during testing.​​

39. Are we using the 274 Provider County Production files or BHIN PACES folder to submit new files?
     The PACES directory is DHCS-PACES/Production/Counties/CountyName_XX/Submit and DHCS-PACES/Production/Counties/CountyName_XX/Response.

    (CountyName is the name of your County) - In this case, DHCS-PACES/Prod/Counties/Los Angeles_19/Submit and so on. 
    

40. If distinct count is different but the response status is accepted; is re-submission required? 
    Yes. If the file was accepted but the counts are not as expected or intended, you must correct and resubmit the file per the directions mentioned in the CG. 

41. What is the link to the new VRF 1.4? 
    

    Link to the schema and documentation: DHCS Documentation Center | General | Microsoft Teams 

    Link to the BH CG 3.01: Behavioral Health 274 Provider Information Documentation ​
    

    
    

1. What's a JSON file? 
   JSON files are a specific format used in transmitting data. 
   

2. I'm still unclear what SRF JSON is.  It might be helpful to spell out the acronym. 
   SRF = Submission Reconciliation File  
   JSON = JavaScript Object Notation
   SRF JSON = Submission Reconciliation File submitted in JSON format
   

3. DHCS sent a revised ECM-CS reporting template that will be effect​​ive in Nov for Q3 2023 data. Will they be replaced at the end of the year?
   More information is coming. Please stay tuned!
   

4. We have started submitting the ECM encounters, so will we have to submit the JSON file for the ECM in near future?
   Yes, MCPs will have to submit both the JSON file and encounters for ECM. 
   

5. Can you provide more details in regard to the ECM and CCM files that will be moving to a new JSON format? Which files will be replaced?
   More information is coming. Please stay tuned!

6. Can you specify what ECM / CS Reports will be built for JSON file? 
   More information is coming. Please stay tuned!
   

7. Is ECM/CS data (JSON) submission going to be monthly?
   Yes.
   

8. ​For the newly required Homeless flag being required for ECM/CS services, how is this data element supposed to be submitted for providers billing electronically via the 837 or via paper on the CMS 1500 form?
   It will be updated as soon as we have a corresponding answer. Thank you for your patience.​
   

9. ​JSON file be separate from MCPD file?
   Yes, it will be separate. 
   

10. ​Are there any plans of changing the 274 file format to JSON?
    The 274 file format is the proprietary delimited text file designed and owned by the X12 organization. X12 is the Standards Development Organization named in the HIPAA laws as the developer of file formats for Electronic Data Interchange. The 274 file is designed using the same format as the X12 837 Claim/Encounter file, the 835 payment remittance advice file, the 834 member enrollment file, and other transactions mandated for use in healthcare data exchange. There are no current plans to change the 274 file format to JSON.  But it will expand.
    

11. When can the plans expect to have the ECM/CS/CCM separate Companion Guide? Will an early draft of the ECM/CS/CCM companion guide be available for comments?
    More information is coming. Please stay tuned!
    

12. ​What email do we use to ensure we are on the distribution list of receiving these ECM/CS JSON notifications?
    These notifications will be sent out to MCPs using our existing email list serve that we have internally. 
    

13. When will the ECM/CS Json phase 2 testing be completed? 
    ECM testing will complete by August 1, 2024.
    

14. When will 274 submission be part of the JSON Format for Counties?
    The 274 is an X12 transaction standard, and as such is NOT in JSON format. Data transaction Standards are more of a "map" of how the data elements are laid out (the order in which they are reported, etc. as well as the rules for each data element). JSON is more a technical file format, similar to .xml
    

15. Is there a json schema file for ECM/CS? We couldn't find it in Teams?
    Yes, within the program template data file, there is schema and tech guide for it

16. ​Is there a recommendation for tools that can convert Excel files to JSON?
    Notepad++, Zappysys, excel2jason library which is python library.​

    
    
    

1. ​ Has DHCS asked for the contacts (up to four) already been sent to MHP/DMC-ODS Counties? 
   DHCS has been asking for MHP and DMC/ODS contacts through the monthly 274 County Workgroup meetings.  The goal is to have four county contact per plan type (e.g., MHP versus DMC-ODS).  DHCS has not sent out a request yet for only four contacts.  We are using the list of contacts currently submitted by the counties.
   

2. Will you be expecting a separate 274 for each category? One for behavioral health, one for drugs and one for dental? Or one to include them all? 
   DHCS requires separate 274 EDI submissions for Medical, Dental and Behavioral Health managed care delivery models.
   

3. MHP and DMC-ODS will have separate 274 submissions? Or is it going to be one submission? 
   Separate 274 EDI submissions will be required for MHP and DMC-ODS submissions.  The Behavioral Health 274 Companion Guide will provide instructions for submitting MHP and DMC-ODS submissions.  The EDI file name and Health Care Plan (HCP) code will distinguish the plan type.   
   

4. For 274 BH, is the expectation that MCPs will send a separate 274 that only includes their BH network in additional to their current 274 submission? 
   DHCS will continue to have separate 274 EDI submissions for County Behavioral Health Managed Care Plans (MHP and DMC-ODS).
   

5. Does that mean the current way of submitting MHP 274 (X12 EDI format) will be replaced by JSON going forward? 
   

   The 274 is not being replaced with a JSON format. The X12 4050 274x109 is formatted in the proprietary and HIPAA mandated Electronic Data Interchange (EDI) format, which is developed and maintained by the X12 organization. 

   The MS Excel based Provider Data Submission Reconciliation File (PDSRF) may be replaced by a similar file utilizing JSON format. This replacement file is referred to as the “Submission Reconciliation File (SRF)".  The transition of the PDSRF to JSON format has not occurred yet.​
   

6. We have separate 274 for SUD/(substance abuse) and Mental health then is what you are saying? 
   DHCS is planning to have separate 274 EDI file submissions for Mental Health Plans and Drug Medi-Cal Organized Delivery Systems.
   

7. Is there any update on when the DMC-ODS 274 companion guide will be available? Can you please advise where the draft guide can be found? 
   ​The Draft Guide is already available for the DMC-ODS 274. It can be found on the 274 Expansion Website; it is Version 2 of the Original Guide.​
   

8. Outside of the 274 mailboxes, how are counties to identify their respective liaison? 
   Liaison not assigned yet because not in production.  All county support will be in workgroup led by Sara Rivera, until the counties are in production status.
   

9. With turnover happening in counties, how do counties find out current contacts of DHCS, update current county contacts (find out who is currently on file with DHCS as a contact and liaison)? 
   Any questions related to the county 274 Expansion Project should be sent to 274Expansion@dhcs.ca.gov. We also have a mailbox for Network Adequacy related questions: NAOS@dhcs.ca.gov.
   

10. Estimated timeline for DHCS to release guidance on QMED 2.0?

    The current project timeline would be targeting 2025 for further details on QMED 2.0.​
    

1. Will Short-Doyle data be pulled daily from the SDMC claim system, or are MHP's supposed to submit different data on a daily basis? 
   MHPs can submit specialty mental health claims to Short Doyle on a daily basis. Typically, though, MHPs may submit claim files 1-3 times per month.
   

2. Is the limit of four (4) contacts per county only related to data quality or is that across the board?  For example, we have four or five people contacting MedCCC for claim question, a couple of people asking about technical, others asking about reporting, etc.  Will we have to change how we triage/assign asking questions? 
   Is the reference to 4 contacts about the number of ‘owners’ for Short Doyle? (2 for SMHS, 2 for DMC) Owners approve and delete data users for a county. 
   ​For MEDCCC, there is no restrictions to the number of county staff that can submit questions. 
   

3. Are there new mental health codes that we will need to use? Are there old codes that will be expired? If so, will these old codes be expired for providers, or will these need to be cross walked like the local codes?
   ​Beginning 7/1/23, under CalAIM​, DHCS is transitioning to CPT codes for behavioral health claiming in Short Doyle. Counties can obtain a listing of CPT and HCPCS codes and claiming rules in the Specialty Mental Health Services and Drug Medi-Cal Billing Manuals posted on the MEDCCC Library. Additional claiming resources are also found on the MEDCCC page.
   

QMED 2.0

Encounter Data Improvment Project​

Others

1. Will you be sharing the methodology that you have used to calculate match rates? Will you also provide guidance on how those #s can be improved? 
   ​​​DHCS has provided the matching methodology to FQHCs and MCPs. If you need a copy, please email FQHCAPM@dhcs.ca.gov. DHCS is working to identify the causes behind low match rates within the applicants for the APM. We will be providing guidance on our findings and how we would recommend FQHCS and MCPs work together to improve the data.​ 
   

2. Does DHCS have a standard definition for Gender Affirming Care, and are these code sets identified?
    For a standard definition, please contact your program area liaison.

3. When will the 834 technical documents with changes for Gender Affirming Care be available?​
   Please refer to the CAPMAN Documentation channel on the DHCS Documentation Center, which contains the current version of the 834, as well as the upcoming version that will take effect on 02/24/2025. For any further questions, please contact your DHCS Contract Manager or your DHCS enrollment/eligibility liaison, if assigned to your organization.