Join Our Network

join3 Join us in our effort to provide quality healthcare to those in need. CenCal Health has a provider inclusive policy and we work with interested and eligible providers in the area.

We are contracted with 94% of the providers who reside in Santa Barbara County and over 75% of the providers who reside in San Luis Obispo County. This represents over 1600 physicians.

We believe in making processes as easy as possible so that you can focus on providing quality healthcare.

Thank you for your interest in joining CenCal Health; your local health plan.

To contract with CenCal Health, providers are strongly encouraged to enroll in the State Medi-Cal program, with the exception of those provider types that are not currently certified by the Department of Health Care Services to provide Medi-Cal services.

The State's PAVE portal is a web-based application designed to simplify and accelerate the State Medi-Cal enrollment process.  Providers can utilize the portal to complete and submit applications, report changes to existing enrollments, and respond to requests for continued enrollment or re-validation.

Department of Health Care Services Medi-Cal Provider Application and Validation for Enrollment (PAVE)

Contracting

To be reimbursed for non-emergent services for an eligible member of a health program administered by CenCal Health, providers must have an executed Agreement for that program. At a minimum, we ask that providers have an executed Agreement for our Health Initiative program(s). To provide emergent care to any Medi-Cal member, 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. Primary Care and Specialty physician groups may choose to contract as a single contracting entity. Facilities and ancillary providers complete the provider panel as determined by each program’s specific needs. In addition, we contract with out-of-area providers as needed to assure the availability of specialized services to members of our programs.

Our Provider Recruitment Representative is available to answer questions and guide prospective providers through the contracting process. Please note that the prerequisites required for participation may vary by program and provider type. Please contact us at (805) 562-1676 or email Provider Services to get started! 

As your relationship and experience with us grows, your Provider Representative, as well as staff from other CenCal Health departments, will be on hand to answer questions, assist with member issues, claims processing and authorizations for referral or treatment, complaints and concerns, and on-going training.

Claims are payable for services rendered on or after the date the contract is fully executed. Claims for services rendered prior to execution of your provider agreement may not be reimbursed.

Credentialing

Like most managed care organizations, we have a quality of care program designed and implemented to continually improve the health plan and the delivery of health care to our members. As part of this program, we credential providers practicing as individuals or belonging to groups contracted with CenCal Health.

Concurrent with the contracting process, most providers will also be required to complete our initial credentialing process, which is based on credentialing standards developed by the National Committee for Quality Assurance (NCQA). Generally, this includes completing and submitting an application and various attachments. CenCal Health’s Credentialing Specialist then verifies the information received, which may include license to practice, education and training, board certification, malpractice insurance and case history, sanction activity, etc. Please note that the requirements vary by provider type; see below for the instructions applicable to your provider type.

Providers requesting access to the information within their credentialing files may do so as permitted by applicable federal and state laws and regulations. Staff and/or CenCal Health’s Provider Credentials Committee review the confidential information and providers are then notified of the outcome in writing. Questions regarding credentialing may be directed to our Credentialing Specialist by emailing Provider Services.

Please do not provide services to members until you receive written notice that your credentialing application has been approved. Claims for services rendered prior to approval of your credentialing application may not be reimbursed.

For Organizational Providers, please fill out the Organizational Provider Application.

For Individual Providers, please follow the guidelines below:

Physicians

(MD, DO, DPM, DDS, PhD, PsyD)

Chiropractors

Allied Providers

(e.g. LAc, IBCLC, OT, OD, PT)

2012 CPPA: sections II thru XII

2012 CPPA: sections II, III, VI, VII and IX thru XI

2012 CPPA: sections II thru IV, VI, VII and XI

Addendum B (if applicable)

Addendum B (if applicable)

Addendum B (if applicable)

Attestation

Attestation

Attestation

Information Release/ Acknowledgments

Information Release/ Acknowledgments

Information Release/ Acknowledgments


CPPA w/Attestation and Information Release/Acknowledgement - this is a fillable form, prompts will appear as you begin each section to indicate whether that section is required for your provider type.

Please Note

Pages 13-15 MUST be printed, signed (not stamped) and dated, we must receive signed copies of these documents prior to beginning to process your application. 

Please print and submit this form via fax it to (805) 683-9203 or email it to providercredentials@cencalhealth.org and keep a copy for your record.

Addendum B - this is a fillable form that will be electronically transmitted to our Credentialing Specialist when you click "Submit". Information you type on this form will NOT be saved, please print it prior to submitting if you wish to keep a copy for your records.  If there are malpractice cases to report within the last 7 years, you may complete Addendum B and/or submit a separate document by fax or e-mail.

To ensure timely processing of your application:

  • If you do not have local hospital privileges at this time, please include an alternative admission plan (hospitalist, CenCal Health provider with privileges that will admit on your behalf, or N/A (radiologists, etc.).
  • Please make sure your peer references’ contact information is current.
  • Work History must include start/end months and years for the past 5 years.
  • After completing your application, be sure to click the "Submit" button in the upper right corner of the screen; if correctly submitted, you should receive a confirmation e-mail. (Does not work with Google Chrome).  Alternatively, you may print it out and fax/email it with the other documents below.
  • A CAQH may be submitted instead of the CPPA.  We are not members.  Please print it out in application format to send and include the items below.
  • Be sure to PRINT, SIGN, and DATE your Attestation (making sure all questions are answered) and Release/Acknowledgement and return by fax or e-mail.
  • Be sure to send copies of your license to practice, liability coverage, DEA (if applicable) and CV if available by fax or e-mail. 

Notice of Practice Changes

Be sure to have the following information available and notify CenCal Health of changes to your practice.  If any of the following changes occur please complete the Provider Information Form (PIF).

  • Medi-Cal Provider Number Changes
  • NPI Changes
  • Practice re-location or new locations added
  • Change in ownership or name
  • New providers join (or providers leave) your practice

Please notify CenCal Health of any changes to your Tax Identification Number by completing the W-9 Form.

enroll in other programs

Do you need to enroll in other county and state programs? Contact these programs below for more information.

Child Health and Disability Prevention Program (CHDP)
Vaccines for Children (VFC)

California Children’s Services (CCS)

CenCal Health partners with The Holman Group for mental health services. For enrollment information, please contact The Holman Group.

CenCal Health does not manage the Medi-Cal Dental Program. For enrollment information, please contact Denti-Cal.

Schedule a New Provider Orientation

providercontact4

Our Provider Services Representatives live and work in your community and are available to visit provider offices.  If you are a newly contracted provider we will come to your office and train you and your office staff with current information and materials so you are prepared when seeing our members. Contact us by phone or email providerservices@cencalhealth.org   

providerteam3