Providers Provider Profile/Practice Changes

Keep Your Provider Information and Practice Changes Up-to-Date

 

The information that CenCal Health has on file regarding a provider practice is important to make sure claims are paid efficiently, your mail reaches you, and your practice is listed accurately in our Provider Directory for members.

By notifying CenCal Health with any practice changes, you are not only complying with your Provider Agreement, but you ensure that CenCal Health is in compliance with the Department of Health Care Services provider data regulations.

The following are changes that require attention:

  • Change "Mail-To" and "Pay-To" addresses
  • Adding additional rendering physicians
  • Add business owners,officers, and managers
  • Change in member age range/quantity of members you are willing to accept
  • Change to office hours
  • Change to languages capabilities provided at your office

Downloadable CenCal Health Provider Roster Template

Please submit changes related to your practice, and/or if you have more than one provider within your practice, via our new downloadable CenCal Health Roster. As a Managed Care Plan, CenCal Health is required to submit a comprehensive roster, which includes all contracted providers, on a monthly basis to the State of California. By using this helpful tool, we are asking for you to partner with us to ensure accurate reporting to the State.

Provider Information Form

Please submit changes on this form if your practice, and/or provider have individual updates. Rosters are highly recommended if you have more than one change within your practice.

W-9 Taxpayer Information Form

If you are a Contracted Provider and have changes to your Tax ID Number, DBA, or legal business name, please submit a new W-9 to CenCal Health.  Please submit this document to your Provider Service Representative via email at psrgroup@cencalhealth.org.

If you are a Non-Contracted Provider and have changes to your Tax ID Number, DBA, or legal business name, please submit a new W-9 to CenCal Health. Please submit this document to CenCal Health's Provider Services Department via fax at (805) 681-3015 or email providerdata@cencalhealth.org.

All of the forms above can be submitted to CenCal Health's Provider Services Department via emailed to providerdata@cencalhealth.org, faxed to (805) 681-3015 or via the Secure File Link https://gateway.cencalhealth.org/form/ps.

Moving or Retiring?

If you decide to leave CenCal Health, please submit a notification letter via email to CenCal Health.  Sixty (60) day advance notification is required for address changes, retirement, or resignation from CenCal Health.  Please email your Provider Service Representative at psrgroup@cencalhealth.org .