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 Credentialing Applications and Forms 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).
- 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 can utilize the portal to complete and submit applications, report changes to existing enrollments, and respond to requests for continued enrollment or re-validation.
If you only see CenCal Health Medi-Cal members and wish to enroll directly through CenCal Health, please contact your Provider Services Representative (PSR) at (805) 562-1676 or or by emailing firstname.lastname@example.org . Please note that CenCal Health is waiving the application fee and the requirement to have any forms notarized. You may return your completed forms directly to us as directed in the FAQ.