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.