Provider Preventable Conditions (PPC)
Since July 1, 2012, Department of Health Care Services (DHCS) requires that all providers are to report PPCs that occur in either inpatient or outpatient settings. A provider must report the occurrence of any PPC in any Medi-Cal patient that did not exist prior to the provider initiating treatment. A provider must report the occurrence, even if the provider does not seek Medi-Cal reimbursement for services to treat the PPC.
A provider reports a PPC by completing and submitting the Medi-Cal provider Preventable Conditions (PPC) Reporting Form linked above to San Francisco Health Plan (SFHP) Utilization Management Department. Please send a form via fax or US mail to:
ATTN: Utilization Management Department
San Francisco Health Plan
P.O. Box 194247
San Francisco, CA 94119-4247
Fax: 1(415) 357-1292
Providers must submit the form within five days of discovering the event and confirming that the patient is a Medi-Cal beneficiary. For more information on PPCs, please visit the DHCS website.