Credentialing Applications and Forms

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 a credentialing  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 psrgroup@cencalhealth.org to get started! 

Physician Provider  

  • Allopathic Physicians (MD)
  • Chiropractor
  • Osteopathic Physicians (DO)
  • Podiatrist (DPM)
  • Psychiatrist
Non-Physician Medical Practitioner
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Nurse Practitioner (NP)
  • Physician Assistant (PA)
Allied Provider
  • Acupuncturist
  • Audiologist
  • 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
  • Optometrist
  • Physical Therapist
  • Physical Therapist Assistant
  • Psychologist
  • Registered Dietician/Nutritionist
  • Speech Language Pathologist

Organizational Provider

  • Ambulatory Surgical Center (freestanding only)
  • Acute Rehabilitation Facility
  • Birth Center (freestanding & licensed only)
  • CBAS (ADHC)
  • Extended Care Facility
  • Home Health Agency
  • Hospice
  • Hospitals – All Types
  • Intermediate Care Facility
  • Kidney Dialysis Centers
  • Laboratories
  • Long Term Care Facility
  • Skilled Nursing Facility
  • Sleep Centers
  • Sub-Acute Facility
  • Transportation Providers

Durable Medical Equipment Provider

Locum Tenens

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.