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 with CenCal Health. 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 Services Representative is available to answer questions and guide prospective providers through the credentialing and contracting process. Please reference our Onboarding Applications and Forms below for prerequisite requirements for participation as it may vary by provider type, and submit a Provider Information Form, in addition to a W-9 Taxpayer Information Form.
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.
As your relationship and experience with us grows, your Provider Services Representative are available to answer questions during this process.
For more instructions about Medi-Cal Enrollment requirements and process, click here.
To verify enrollment with State Medi-Cal, you may search the Department of Health Care Services' (DHCS) database via the link below (click "Preview" and enter your National Provider Identifier (NPI) in the search field on the Data Table).
- Physicians and most other provider types, please click here
The State's PAVE portal is a web-based application designed to simplify and accelerate the State Medi-Cal enrollment process. Providers must utilize the portal to complete and submit applications, report changes to existing enrollments, and respond to requests for continued enrollment or re-validation. Please be sure to maintain current and accurate information about yourself and/or your group, as data submitted through PAVE comprises the database DHCS uses to understand the network of Medi-Cal providers in California. This is important even if you only see CenCal Health members and never submit claims for Fee-For-Service members.
CenCal Health has a quality of care program designed to 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 our contracting process, most providers will also be required to complete an Onboarding packet below. CenCal Health is now credentialing mental health providers offering services to CenCal Health members at a Federally Qualified Healthcare Center (FQHC). Please note that the packet requirements vary by provider type.
Please do not provide services to members until you receive written notice that your application has been approved. Claims for services rendered prior to this approval and executed contract may not be reimbursed.
Our Provider Services Representatives are available to answer questions and guide prospective providers through this onboarding process and will notify you of your effective date with CenCal Health. Please contact us at (805) 562-1676 or email@example.com to get started!
Non-Physician Medical Practitioner
- Allopathic Physicians (MD)
- Osteopathic Physicians (DO)
- Podiatrist (DPM)
- Certified Nurse Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Behavioral Health Nurse - RN, LPN, NA
- Board Certified Behavioral Analyst (BCBA) or Board Certified Associate Behavior Analyst (BCaBA)
- Certified Diabetes Educator
- Clinical Social Worker
- Hearing Aid Dispenser
- International Board-Certified Lactation Consultant
- Licensed Clinical Social Worker (LCSW)
- Marriage and Family Therapist (LMFT)
- Occupational Therapist
- Physical Therapist
- Physical Therapist Assistant
- Registered Dietician/Nutritionist
- Speech Language Pathologist
- Ambulatory Surgical Center (freestanding only)
- Acute Rehabilitation Facility
- Birth Center (freestanding & licensed only)
- CBAS (ADHC)
- Extended Care Facility
- Home Health Agency
- Hospitals – All Types
- Intermediate Care Facility
- Kidney Dialysis Centers
- Long Term Care Facility
- Skilled Nursing Facility
- Sleep Centers
- Sub-Acute Facility
- Transportation Providers
Durable Medical Equipment Provider
Please fill out the Locum Tenens Notification Form. Locum tenens are providers who temporarily take the place of, or cover, for another provider. All Locum Tenens who render services to CenCal Health members must be disclosed to the our Provider Services staff before providing care to CenCal Health members. Please fill out the Locum Tenens Notification form for all Locum Tenens prior to their starting at your practice.