Policies & Procedures

providercontact5CenCal HEALTH  has established Polices and Procedures under which the agency operates. Such policies are established to insure that departments within CenCal Health work effectively together in day to day processes. 

CenCal Health Policies and Procedures include those most important for contracted providers to have available for review. These Policies and Procedures may be updated from time to time, and when they are so updated, the new Policy and Procedure will be made available to you to replace those currently contained in this Provider Manual. Most changes to these Polices and Procedures are considered non material and reflect changes in CenCal Health’s day to day processes or regulatory required changes. 

Fraud, Waste and Abuse Identification, Reporting and Investigation

Access to Care

Individual Health Education Behavioral Assessment: the Staying Healthy Assessment

Member Grievance System

Provider Credentialing and Peer Review Policy

Medi-Cal Facility Site & Medical Record Quality Improvement Program

Provider Grievance System    Provider Grievance Form

Coordination of Care

Continuity of Care

Clinical Utilization (UM) Criteria