Providers Welcome to the Network

Welcome to the Network! Take the Next Steps

providercontact2You are joining a large network of providers and hospitals. Our goal is to help you give our patients the highest quality, safest and most cost-efficient care. CenCal Health has the experience to understand your needs and offer online tools to reduce administrative burden for you and your staff through our secure provider portal.  We have provided many resources for you including our New Provider Training Operations Guide, and video training resources on how to check a members monthly eligibility, Authorizations, and most importantly Cultural Competency, Health Literacy & Communicating with Seniors or Persons with Disabilities (SPD).   

Our trainings provide information on our benefits and services, as well as important processes and procedures necessary to conduct business with CenCal Health.  We require all new Provider Groups and Rendering Physicians to review these details and sign-off on our Attestation Form located on the last page of the ‘New Provider Training Operations Guide & Attestation’ linked below.

New Provider Training Resources & Videos:

Click here to view additional training events throughout the year, and additional resources. 

We highly recommend that you and your team review all of these resources. Please contact your Provider Services Representative at (805) 562-1676 or email us at psrgroup@cencalhealth.org to schedule a 1:1 training today!

Facility Site Reviews (New Primary Care Providers)

CenCal Health conducts facility site reviews for new primary care providers as a requirement for participation in all CenCal Health programs.  After the initial site review, the maximum time period before the next required site review is three years. Interim monitoring will occur within this time period to assess compliance to the critical elements of the site review, or to follow up with findings from previous reviews. CenCal Health may review sites more frequently, or when determined necessary based on prior findings. 

Please refer to the Facility Site Review section of the website for forms to assist you and your office in preparing for this site visit.

 

Basics on Eligibility

CenCal Health does not determine eligibility. Eligibility is determined by Department of Social Services (DSS) and Social Security Administration (SSA). It is important to verify eligibility because:

  • A Benefit Identification Card (BIC) and/or a Member ID Card is not a guarantee of eligibility
  • Members may have a Share of Cost
  • Members may have Other Health Coverage
  • Members may have changed their Primary Care Provider
  • Member might be Special Class and not have a Primary Care Provider

Click here to learn how to check a Member's eligibility.