Section 4: Provider Relations

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Table of Contents - Medi-Cal​​

​​​​​​​Policy/Procedure Title​​

   ​​Policy Number

​​          Summary of PHC​ Access and Availability Standards

​​

​          PHC Provider Directory

​   ​      ​​Introduction to the Provider Relations Departm​ent

Credentials Committee

MPCR1​

​​Credential and Re-credential Decision Makin​​​​​g Process

​​​MP CR 100​

​ Ensuring Non-discriminatory Credentialing and             Re- credentialing Processes

​​​MP CR 101

Provider Directory Accuracy

​​​MP CR 102


​ Medi-Cal Managed Care Plan Provider Screening and Enrollment


MP CR 20​

​Credentialing Committee and CMO Credentialing Program Responsibilities

MP CR 200​

Physician Credentialing and Re-Credentialing  Requirements

MP CR 300​

Attachment A: Original Source Verification Links for Credentials Vetting

Attachment B: Notice of Credentialing Rights and Responsibilities

Attachment C: Practitioner Types Credentialed by Partnership HealthPlan of California

​Non-Physician Clinician Credentialing and Re-Credentialing Requirements

MP CR 30​1

​Attachment A: Original Source Verification Links for Credentials Vetting

​Attachment B: Notice of Credentialing Rights and Responsibilities

Attachment C: Practitioner Types Credentialed by Partnership HealthPlan of California

​Behavioral Health Practitioner Credentialing and Re-Credentialing Requirements

​MP CR 302

Attachment A: Original Source Verification Links for Credentials Vetting

Attachment B: Notice of Credentialing Rights and Responsibilities

Attachment C: Practitioner Types Credentialed by Partnership HealthPlan of California

​Applied Behavioral Health Provider Credentialing and Re-Credentialing Requirements

​MP CR 303

​Attachment A: Original Source Verification Links for Credentials Vetting

​Attachment B: Notice of Credentialing Rights and Responsibilities

​Attachment C: Practitioner Types Credentialed by Partnership HealthPlan of California

​Allied Health Clinician Credentialing and Re-Credentialing Requirements

​MP CR 304

Attachment A: Original Source Verification Links for Credentials Vetting

​Attachment B: Notice of Credentialing Rights and Responsibilities

​Attachment C: Practitioner Types Credentialed by Partnership HealthPlan of California

​Provider Credentialing and Re-credentialing Verification Process and Record Security

​MP CR 400​

Attachment A: Credentialing Verification Sources used by Partnership Healthplan of California for Individual Practitioners 

​Attachment B.1: Initial Credentialing Checklist

Attachment B.2: Physician Re-Cred Audit Worksheet

Attachment B.3: Non-Physician Clinician Intial Cred Audit Worksheet

Attachment B.4: Non-Physician Clinician Re-Cred Audit Worksheet

​Attachment B.5: Allied Health Intial & Re- Cred Audit Worksheet

​Attachment B.6: Ancillary Intial & Re- Cred Audit Worksheet

​Attachment B.7: Facility Provider Intial & Re- Cred Checklist

​Attachment B.8: Long Term Care - Skilled Nursing Facility Provider Intial & Re- Cred Checklist

​Attachment B.9: Stand Alone Birth Centers Intial & Re- Cred Checklist

​Attachment C: Confidentiality Statement

Identification of HIV/AIDS Specialists 

​MP CR​​ 4 B

Identification and Notification of HIV/AIDs Specialist Attestation Questionnaire​​​​​​

​         Ongoing Monitoring and Interventions

MP CR 500​

Monitoring Resources for Sanctions and Disciplinary Actions

​​​​​Ra​nge of Actio​​​ns to Improve Practitioner Performance​​​​​​​​​​

​​​​​​MP CR 600​

​​Fair Hearing Process for Adverse Decisions

​​MP CR 601​

​​Reporting Actions to Authorities​

​MP CR 602

​​​As​​​sessment of Orgnizational Providers

​​​MP CR 700​

Delegation of Credentialing ​​and Re-credentialing Activities​​​​

M​​​P​​ CR 800​

Credentialing of Independent Nurses under EPSDT

​​​​​MP CR  12

​​​​Individual Nurse Agreement

Credentialing of Pain Management Specialist

​MP CR  13

Credentialing of Hospice and Palliative Care Medicine Specialist

​​MP CR  13 A

​​​​​​Buprenorphine Prescriber Credentialing

​​​​MP CR 13 B​​

​         Osteopathic Manipulation Treatment Credentialing

MP CR 13 C​

​​​Pharmacy Provider Assessment Criteria

​​MP CR  14

Lactation Consultant Credentialing Policy

​​MP CR 16

​​Standards for Contracted Primary Care Providers

​​MP CR  17

 

​​​​​Primary Care Provider Criteria Form​

Skilled Nursing Facility Providers (SNFs) Credentialing Policy​​​

​​​​MP CR 19​

​​PHC Provider Contracts

​​​MP PR  200

​​PCP Availability and Capacity Policy and Procedure

​​MP PR  201

​​Network Availability Standards Policy and Procedure

​MP PR  201 A

​​Monitoring of PHC Specialist Physician Network Availability Policy & Procedure

​MP PR  202

Reporting of PHC Specialist Physician Network Availability

​​MP PR  202 A

​​Provider Enrollment Status Guidelines

​MP PR  203

​​Monitoring of PCP Accessibility of Services Policy & Procedure

​MP PR  205

​​PHC Annual Physician Satisfaction Survey

​​MP PR  207

​​PHC Provider Termination or Change in Location Information

​​MP PR  208

​​​​Provider Change Form​​​​​

​​​​Provider Contract Termination or Site Closure Form​​​​

​​Provider Grievance

​​MP PR-GR  210

​​​​​​​​​​​​​​​​Archived Policies​

MPCR2 - Credentialing and Re-cred​​entialing Committee Authority and Responsibility  

​Archived 06/30/2018

​​MPCR5 - Review Standards for Credentials, Re-credential Process​

Archived 06/30/2018​

​​MPPLPR CR 201 -  Credentials Committee Review​

Archived 06/302018​​

​​MPCR9 - Fair Hearing Process For Adverse Decisions ​​

Archived 05/09/2018​​

​​​MPCR9A - Reporting to the Medical Board of California and the National Practitioner Data Bank

Archived 05/09/2018​​

​​MPCR10 - Organizational Providers Assessment Criteria​

Archived 06/30/2018​

​​​MPCR11 - Delegation of Credentialing and Re-credentialing Activities

​Archived 06/30/2018​​

MPCR11A - Review of Delegated Credentialing and Re-credentialing Policies​​

    ​​​Archived 06/30/2018​

​ MPPRPLCR701 - Re-credentialing Document Collection, Review, Verification and Ongoing            Monitoring of Sanctions and Complaints

Archived 6/13/2018​

MPPRPLCR701A - Re-credentialing Document Collection, Review and       Verification, and Performance Monitoring for Behavioral Health Practitioners


  ​Archived 6/18/2018

​MP CR  4  - Initial Credentialing Requirements

​ ​Archived 8/8/2018

MP CR  4 A - Initial Credentialing Criteria, Application/Attestation, and Monitoring of        Sanctions for Behavioral Health Practitioners

Archived 8/8/2018​

MP PR RL CR 401 - Credentials Document Collection, Review, and Verification

​Archived 8/8/2018

MP PR PL CR 401A - Credentials Document Collection, Review, and Verification for Behavioral Health Practitioners

​Archived 8/8/2018

MP PR RL CR701 - Re-credentialing Document Collection, Review, Verification and Ongoing Monitoring of Sanctions and Complaints

​Archived 8/8/2018

MP PR PL CR 701A - Re-credentialing Document Collection, Review and Verification, and Performance Monitoring for Behavioral Health Practitioners

​Archived 8/8/2018

​MP CR  6 - Non-Physician Medical Practitioner Credentialing Criteria

​Archived 8/8/2018

MPCR6A - Initial Credentialing R​​​equirements for Non-Physician (Allied Health) Practitioners

​Archived 8/8/2018

​MP CR  7 - Re-credentialing Requirements​

​Archived 8/8/2018

MP CR  7 A - Re-credentialing Criteria, Application/Attestation, and Monitoring of Sanctions for Behavioral Health Practitioners

​Archived 8/8/2018

MPCR 8 - Delegation of Credentialing ​​and Re-credentialing Activities​​​​

​Archived 8/8/2018

MP CR  18 - Applied Behavioral Health Provider Credentialing Policy

Archived 8/8/2018

​MP PR SA 212 - ​​Access Standards for Substance Abuse Services

Archived 9/12/2018​

​MP PR SA 213 - ​​​Availability of Substance Abuse Clinicians/​​​​Outpatient Facilities

​    Archived 9/12/2018

​Please Direct Questions To:

Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
Phone: (707) 863-4100