Mission of PED
The mission of the Provider Enrollment Division (PED) is to enroll eligible providers in the Medi-Cal program on a timely basis and continually update the Provider Master File to accurately reflect provider status.
Allied & Physician Section
Two of the three units in this section are responsible for the analytical review, verification of information, approval and processing of provider applications for enrollment of provider types such as physicians, non-physician medical practitioners, and allied healthcare providers into the Medi-Cal program. These units are also responsible for the enrollment of health care provider groups. The third unit in this section is responsible for researching and resolving returned warrants, which includes verification of current addresses and communication with the State Controller's Office, providers, and HP Enterprise Services for the reissuance of warrants and/or deactivation of provider number, if appropriate.
Facility/Pharmacy/PMF Branch
This Branch consists of three units. Two of the units are responsible for the analytical review, verification of information, approval and processing of provider applications for enrolling medical outpatient services, equipment and supplies provider types such as pharmacy, laboratory, and durable medical equipment providers into the Medi-Cal program. They are also responsible for verification and approval of enrollments for Medi-Cal providers registered in special programs such as Early and Periodic Screening Diagnosis and Treatment Services (EPSDT), and Family Planning Access, Care and Treatment (FPACT). The third unit, the Provider Master File Unit (PMF), is responsible for special projects and activities that support or enhance the provider enrollment functions, such as database management and onsite referrals. This unit works with the fiscal intermediary to develop provider files and implement rate changes that meet the agency’s requirements. This unit also provides oversight of the Technical Support Unit which is responsible for key data entry of all data into Provider Master File.
Policy & Administrative Branch
This Branch has four units. The Policy Section, with two units, is responsible for developing and implementing enrollment policy and procedures, providing in-depth analytical research and review, developing and implementing new regulations, analyzing legislation and designing forms and online documents in support of the provider enrollment and re-enrollment processes. These units work closely with many department divisions and branches, Department of Justice, and other State and federal agencies. The Administrative Unit is responsible for in-depth research and development of budget change concepts and proposals, and contracts. This unit is the liaison for the Legislative and Governmental Affairs (LGA) office, Department’s Personnel Office, and other state and federal offices. Staff researches and responds to Public Records Act requests, certified copy requests, correspondence from all levels of government, and provider inquiries. The Program Support Unit is responsible for the sorting and distribution of all incoming and outgoing mail, logging and tracking of all applications received for enrollment in the Medi-Cal program, document tracking, and special projects. This unit also is responsible for typing, formatting, and releasing correspondence letters, returned mail, document scanning and indexing, and document destruction.
Re-Enrollment Section
The two units in this section are responsible for expanding the anti‑fraud activities through the re-enrollment of existing providers. These units review re-enrollment applications, disclosure statements, provider agreements and all applicable licensure for all provider types on a rotating basis. Further, this section provides in-depth analysis and background checks to assist Audits and Investigations in their on-site review of re-enrolling providers, and coordinates the Suspended and Ineligible Provider List.
