Contra Costa County payment to Sutter Health will be offset by a “charitable contribution in the form of a credit” from Epic, Inc. in the amount of one million eight-hundred thousand dollars ($1,800,000) which credit will be reflected in Epic’s invoicing for the year 2022. There is no net cost to the County.

The California Department of Health Care Services (DHCS) sponsors the Private Hospital Directed Payment Program (PHDP Program). The PHDP Program directs managed care plans, including CCHP, to reimburse private hospitals based on actual utilization of contracted services. Payment is contingent upon hospitals providing adequate access to service, including primary, specialty, and inpatient care.   
  
In March 2021, Sutter Health discovered that claims for services that its affiliated hospitals had provided to CCHP members had not qualified for reimbursement through the PHDP Program. The services were provided from July 1, 2019, through December 31, 2019, at Alta Bates Summit Medical Center and Sutter Delta Medical Center.  
  
DHCS explained that it denied the claims and determined that Sutter did not qualify for the PHDP payments because the National Provider Identification (NPI) on the non-reimbursed claims did not match the NPIs for Sutter. A claims system issue, which arose when CCHP submitted the NPI data to DHCS through Epic’s software system, caused DHCS to be unable to properly read the NPI data.  
  
The claims system issue prohibits Sutter from receiving payment for the claims for services provided to CCHP members from July 1, 2019, through December 31, 2019, at Alta Bates Summit Medical Center and Sutter Delta Medical Center. Sutter and CCHP agree that it is in their mutual best interests to settle and resolve the PHDP Program payment deficit to avoid potential service disruption and the expense of litigation.

Failure to authorize execution of the settlement agreement and to authorize payment may result in litigation and potential disruption to services.