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Primary Care Payment Increase Attestation

Provider news | Tuesday, September 3, 2013

As you may be aware, Section 1202 of the Affordable Care Act (ACA) increases payments to the Medicare equivalent for specified services for qualified Medi-Cal providers effective January 1, 2013.

In order to be eligible for enhanced payment, the physician rendering or supervising the service must personally attest to be the following:

  1. Physician with a specialty designation of Family Medicine, General Internal Medicine, or Pediatric Medicine, or a subspecialty within one of these specialties.

  2. Meet at least one of the following qualifications:
  3. a) Board Certified in a specialty or sub-specialty listed above.
  4. b) At least 60% of total codes billed or paid were for E&M (99201 - 99499) and Vaccine Administration (90460, 90461, 90471 - 90474, or their successors) services.

All physicians who wish to attest to their eligibility may do so by completing the form on-line located on the DHCS web site.

You do not need to be a Medi-Cal certified provider in order to complete the form on the DHCS web site.

If you are directly contracted with SCFHP please call our Provide Services Department with any questions at 1-408-874-1788.

If you are contracted with SCFHP through one of our contract provider groups, such as PMG, PAMF, Premier Care, please contact your provider group with any questions