Updated Instructions for 2024 SNF WQIP Reconciliation
The Department of Healthcare Services has issued updated instructions for the 2024 reconciliation process related to the Skilled Nursing Facilities (SNF) Workforce and Quality Improvement Program (WQIP). This program involves directed payments within the Medi-Cal Managed Care system.
Accessing Encounter Files
To assist facilities in verifying encounter data and ensuring accurate scoring and reimbursement, the Health Plan of San Joaquin and Mountain Valley Health Plan have provided the CY24 encounter files via the File Exchange portal using Doctors Referral Express (DRE). These files detail the qualifying bed days supplied to members during 2024.
Facilities are advised to download their specific encounter files from the DRE Provider Portal, under the File Exchange section labeled WQIP DHCS Reconciliation. If discrepancies or missing data are discovered:
- Confirm that all relevant claims have been submitted and paid.
- For unpaid or unsubmitted claims, submit corrected claims through your usual clearinghouse channels.
- There is no need to re-upload spreadsheets.