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.
- Compliance Plan 2026 (the Provider Code of Conduct can be found on pgs. 32-35)
- Provider Grievance Form
- PS-CR08 Initial Health Appointment
- PS-CR04 Timely Access to Care Requirements and Ongoing Monitoring
- PS-CR03 Provider Credentialing and Recredentialing
- PR-09 Provider Complaints and Grievances
- MS-23 Member Appeals of Adverse Benefit Determinations
- MS-22 Member Grievances and Appeals of Grievance Resolution
- HS-UM20 Utilization Review – Prior Authorization, Concurrent Review, and Retrospective
- HS-UM 22 Clinical Criteria for Utilization Management Authorization Decisions
- HS-UM07 Notification of Utilization Review Determinations