Provider Manual

The Provider Manual includes information such as Provider enrollment,  Responsibilities, Claims information, Member eligibility, Guidelines for medical authorizations. If you have any questions about this publication please contact the Provider Services Department at (805) 562-1676 or by sending an email to Provider Services

Click here to view our current CenCal Health Provider Manual or click the links below to access individual sections.


Table of Contents

Section A:  Introduction    

Section B:  Provider Resources

Section C:  Provider Responsibilities

Section D:  Contracting and Credentialing

Section E:  Covered Services

Section F:  Services Covered by Other Agencies

Section G:  Eligibility Verification and Enrollment

Section H:  Health Services 

Section I:  Disease Management Programs

Section J:  Claims and Billing Guidelines

Section K:  Quality Management

Section L:  Member Services

Section M:  Health Education

Section N:  Fraud, Waste and Abuse

Section O:  Forms


Facility Site & Medical Record Review