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 Department

Credentials Committee

MP CR  1

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

MP CR  2

Credentials Committee Review

MP PR-PL-CR  201

Initial Credentialing Requirements

MP CR  4

Addendum to CP​PA: Credentialing Rights and​Responsibilities​​

Initial Credentialing Criteria, Application/Attestation, and Monitoring of Sanctions for Behavioral Health Practitioners

MP CR  4 A

Identification of HIV/AIDS Specialists 

MP CR  4 B

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

Credentials Document Collection, Review, and Verification

MP PR-PL-CR  401

​​​​​​Addendum to CPPA: Credentialing Rights and Responsibilities

Credentials Document Collection, Review, and Verification for Behavioral Health Practitioners

MP PR-PL-CR  401 A

Review Standards for Credentials, Re-credential Process

MP CR  5

Non-Physician Medical Practitioner Credentialing Criteria

MP CR  6

​​​​​​​​Addendum to CPPA: Credentialing Rights and Responsibilities

​​

Initial Credentialing Requirements for Non-Physician (Allied Health) Practitioners

MP CR  6 A

Ra​nge of Actions to Improve Practitioner Performance​​​​​​​

MP CR 600​

​​Fair Hearing Process for Adverse Decisions

MP CR 601​

​Reporting Actions to Authorities​

​MP CR 602

Re-credentialing Requirements​

MP CR  7

​​​​​Addendum to CPPA: Credentialing Rights and Responsibilities

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

MP CR  7 A

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

MP PR-PL-CR  701

​​​​​Addendum to CPPA: Credentialing Rights and Responsibilities

Re-credentialing Document Collection, Review and Verification and Ongoing Monitoring of Sanctions and Complaints for Behavioral Health Practitioners

​​

MP PR-PL-CR  701 A

​​​​Addendum to CPPA: Credentialing  Rights and Responsibilities

Non-Physician Medical Practitioner Re-credentialing Criteria

MP CR  8

​​​​​​Addendum to CPPA: Credentialing Rights and Responsibilities​

Fair Hearing Process For Adverse Decisions ​

Archived 05/09/2018

MP CR  9

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

Archived 05/09/2018

MP CR  9A

Organizational Providers Assessment Criteria

MP CR  10

Delegation of Credentialing and Re-credentialing Activities

MP CR  11

Review of Delegated Credentialing and Re-credentialing Policies

MP CR  11 A

​​​​​​Delegation Grid Audit Tool​​

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​​

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​

Applied Behavioral Health Provider Credentialing Policy

MP CR  18

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

Access Standards for Substance Abuse Services

MP PR-SA  212

Availability of Substance Abuse Clinicians/Outpatient Facilities

MP PR-SA  213

​Please Direct Questions To:

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