CenCal Health is a local non-profit agency that is committed to providing healthcare to those in need. Our provider network consists of over 1,350 providers servicing 100,000 members. New prospective providers interested in contracting with CenCal Health are encouraged to contact the Provider Services department at 805.562.1676 or 800.421.2560, ext. 1676, or by e-mail to psrgroup@cencalhealth.org.

In line with our provider-inclusive philosophy, we work with all interested and eligible providers in Santa Barbara and San Luis Obispo counties. To contract with CenCal Health, providers are strongly encouraged to enroll in the State Medi-Cal program, with the exception of those provider types that are not currently certified by the Department of Health Care Services to provide Medi-Cal services.

Department of Health Care Services Medi-Cal Provider Enrollment

To be reimbursed for non-emergent services for an eligible member of a health program administered by CenCal Health, providers must have an executed Agreement for that program. At a minimum, we ask that providers have an executed Agreement for our Health Initiative program(s). To provide emergent care to any Medi-Cal member, providers need only be enrolled in the State Medi-Cal program.

Primary Care Physicians (PCPs) and specialists may contract with CenCal Health either individually, in groups, or as outpatient clinic providers. Primary care and specialty physician groups may choose to contract as a single contracting entity. Facilities and ancillary providers complete the provider panel as determined by each program’s specific needs. In addition, we contract with out-of-area providers as needed to assure the availability of specialized services to members of our programs.

Provider Services Representatives are available to answer questions and guide prospective providers through the contracting process. Please note that the prerequisites required for participation may vary by program and provider type. Claims are payable for services rendered on or after the date the contract is fully executed. Claims for services rendered prior to execution of your provider agreement may not be reimbursed.  Your assigned Provider Services Representative will then schedule a New Provider Orientation to introduce you and your staff to the information you need to work effectively with CenCal Health. As your relationship and experience with us grows, your Provider Representative, as well as staff from other CenCal Health departments, will be on hand to answer questions, assist with member issues, claims processing and authorizations for referral or treatment, complaints and concerns, and on-going training.

Credentialing

CenCal Health has always strived to bring the best care possible to members of the programs we administer. Like most managed care organizations, we have a quality of care program designed and implemented to continually 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 the contracting process, most providers will also be required to complete our initial credentialing process, which is based on credentialing standards developed by the National Committee for Quality Assurance (NCQA). Generally, this includes completing and submitting an application and various attachments. CenCal Health’s Credentialing Specialist then verifies the information received, which may include license to practice, education and training, board certification, malpractice insurance and case history, sanction activity, etc. Please note that the requirements vary by provider type; see below for the instructions applicable to your provider type.

Providers requesting access to the information within their credentialing files may do so as permitted by applicable federal and state laws and regulations. Staff and/or CenCal Health’s Provider Credentials Committee review the confidential information and providers are then notified of the outcome in writing.  Please do NOT provide services to members of our programs until you receive written notice that your credentialing application has been approved. Claims for services rendered prior to approval of your credentialing application may not be reimbursed. Questions regarding credentialing may be directed to Cindy Lansing, CPCS, Credentialing Specialist, at extension 1670, or to Sheila Thompson, RN, CPHQ, QI Manager, at extension 1677.

CPPA w/ Attestation and Information Release/acknowledgements- this is a fillable form that will be electronically transmitted to our Credentialing Specialist when you click “Submit”. Information you type on this form will NOT be saved, so please print it prior to submitting it if you wish to keep a copy for your records. Prompts will appear as you begin each section to indicate whether that section is required for your provider type. The Attestation and Information Release/Acknowledgements (pages 13-15) MUST be printed, signed (not stamped) and dated, and submitted by fax to 805.681.3012 or by e-mail to clansing@cencalhealth.org. We must receive signed copies of these documents prior to beginning to process your application.

Addendum B - this is a fillable form that will be electronically transmitted to our Credentialing Specialist when you click "Submit".  Information you type on this form will NOT be saved, so please print it prior to submitting it if you wish to keep a copy for your records.  If there are malpractice cases to report, you may complete Addendum B and/or submit a separate document by fax or e-mail.

CPPA w/Attestation and Information Release/Acknowledgement

Addendum B


 

Remember to notify CenCal Health of changes to your practice!

Let us know as soon as possible if any of the following changes occur by completing the Provider Information Form (PIF) below.

• Medi-Cal Provider Number changes

• NPI changes

• Practice re location or new locations added

• Changes to phone number, fax number, or e-mail address

• Change in ownership or name

• New providers join (or providers leave) your practice

Provider Information Form (PIF)
   
Please notify CenCal Health of any changes to your Tax Identification Number by completing the W-9 form below

W-9 Request for Taxpayer Information