Provider Forms

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.