| Provider Contracting
CenCal Health works with all interested and eligible health care providers in Santa Barbara and San Luis Obispo Counties. Central to the
CenCal Health's philosophy is to be a provider-inclusive program rather than restricting members to a small number of exclusive contractors. To contract with
CenCal Health, providers are strongly encouraged to enroll
in the State Medi-Cal program and at a minimum have an
executed Agreement for CenCal Health's Health Initiative
programs. (Note: nutritionists, diabetes educators and
lactation consultants are relieved of the former requirement
as these are not currently certified by the Department of
Health Services to provide Medi-Cal Services.)
Medi-Cal Website Provider Enrollment
The Provider Services Department is responsible for all matters related to provider participation, including but not limited to: contracting, credentialing, contract compliance, provider complaint, concern and grievances, and provider education. All prospective providers are referred to this department.
Credentialing
CenCal Health has a quality assessment and improvement plan for providers which includes facility audits, medical records review, and credentialing.
Currently, a copy of the California Participating Physician Application is sent to prospective physician providers, along with the appropriate Medical Service Agreement. Once the completed application and requested attachments are received, the Provider Services Credentialing Specialist verifies the license, DEA, board certification, peer references, hospital privileges, malpractice insurance and case history, and any sanctioning activity. Physicians requesting access to the information within their records may do so as permitted by applicable federal and state laws and regulations.
CenCal Health's Credentials Committee will review the confidential information and providers will then be notified of the outcome in writing.
Credentialing Application
Contracting
To be reimbursed for non-emergent services for eligible members of the health programs administered by
CenCal Health, providers must be contracted for that program. For emergent care, providers need only be enrolled in the State Medi-Cal program.
Primary care physicians (PCPs) and specialists may contract with
CenCal Health either individually, in groups, or as outpatient clinic providers. Formal groups of primary care and specialty physicians may choose to contract with
CenCal Health as a single contracting entity. Hospitals, pharmacies, and other ancillary providers complete the provider panel as determined by each program's specific needs. In addition,
CenCal Health contracts with out-of-network providers as needed to assure the availability of specialized services to its members.
Providers are assigned a Provider Services Department Representative who will answer questions and discuss the contract process. Providers are given the appropriate agreement and amendment for their type or specialty. The representative will discuss prerequisites required for participation which may differ for each program administered by
CenCal Health. Provider Services follows up with prospective providers and reviews returned agreements for completion and compliance. The agreement is sent for signatures to
CenCal Health's Attorney, Chairperson of the Board of Directors, and the Clerk of the Board for attestation. Claims are payable for services on or following the execution date of the contract.
Following receipt of a completed agreement, the Provider Services Representative will schedule an orientation with the new provider to furnish pertinent information about working with
CenCal Health. For more information, please contact the Provider Services Department: by phone at (805) 685-9525 or (800) 421-2560, extension
1676; by fax at (805) 685-9828; or by e-mail to
providerservices@cencalhealth.org.
Notification of Practice Changes
Remember to notify
CenCal Health of changes to your practice!
Let
CenCal Health know as soon as possible if any of the following changes occur by completing the Provider Information Form (PIF) below.
- Medi-Cal Provider Number
- Practice Location or Additional Locations
- Phone Number, Fax Number, Email
- Change in Ownership or Name
- New providers added to your practice
Provider Information Form (PIF):
Please notify
CenCal Health of any changes to your Tax Identification Number by completing the W-9 form below.
W-9 Request for Taxpayer Information
If you have any questions, please contact Provider Services at (805) 685-9525, ext
1676. | 
