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Policies & Procedures

CenCal 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.

PS-CR04 Timely Access to Care Requirements and Ongoing Monitoring

PS-CR08 Initial Health Assessment

MS-22 Grievances

MS-23 Member Appeals

PS-CR03 Provider Credentialing and Recredentialing

PS-CR07 Provider Complaints and Grievances

Provider Grievance Form

HS-UM07 Notification of Utilization Review Determinations

CenCal Health Compliance Plan (Reference pgs. 16 – 18 for Provider Code of Conduct)

MM-UM22 Clinical Criteria for Utilization Management Authorization Decisions

HS-MM49 Utilization Review – Prior Authorization, Concurrent Review, and Retrospective Review