Welcome to the Network! Here is What is Next

providercontact2You are joining a large network of providers and hospitals. Our goal is to help you give your patients the highest quality, safest and most cost-efficient care. CenCal Health has the experience to understand your needs and the online tools to reduce administrative burden for you and your staff through our secure provider portal. Here is what you need to know before you see your first CenCal Health member.

New Provider Orientation & Training

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All new CenCal Health providers are required to complete a new provider orientation. This training provides information on our benefits and services, as well as important processes and procedures necessary to conduct business with us.  Call our Provider Services Representative Team at (805) 562-1676 to schedule an on-site training today!

New Provider Orientation Packet

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

Facility Site Reviews

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.

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