Section 4: Provider Relations

Table of Contents - Medi-Cal

Policy/Procedure Title	Policy Number
Health Care Providers' Bill of Rights
Summary of Partnership HealthPlan of California Access and Availability Standards
Partnership Provider Directory
Introduction to the Provider Relations Department
Access Standards and Monitoring	MP NET 100
Attachment A: Standards for Core Specialists
Wellness & Recovery Access Standards and Monitoring	MP NET 101
Credential and Re-credential Decision Making Process	MP CR 100
Attachment A: Routine Practitioners List
Ensuring Non-discriminatory Credentialing and Re-credentialing Processes	MP CR 101
Attachment A: Non-Discrimination Agreement
Provider Directory Accuracy	MP CR 102
Medi-Cal Managed Care Plan Provider Screening and Enrollment	MP CR 20
Attachment A: Provider Types and Categories of Risk/Screening Requirements
Attachment B: Managed Care Provider Enrollment Disclosure Background
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
Non-Physician Clinician Credentialing and Re-Credentialing Requirements	MP CR 301
Attachment A: Original Source Verification Links for Credentials Vetting
Attachment B: Notice of Credentialing Rights and Responsibilities
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
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
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
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 Initial Cred Audit Worksheet
Attachment B.4: Non-Physician Clinician Re-Cred Audit Worksheet
Attachment B.5: Allied Health Initial & Re- Cred Audit Worksheet
Attachment B.6: Ancillary Initial & Re- Cred Audit Worksheet
Attachment B.7: Facility Provider Initial & Re- Cred Checklist
Attachment B.8: Long Term Care - Skilled Nursing Facility Provider Initial & Re- Cred Checklist
Attachment B.9: Stand Alone Birth Centers Initial & 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
Range 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
Assessment of Organizational Providers	MP CR 700
Attachment A: Credentialing Verification Sources used by Partnership HealthPlan of California for Organizational Providers
Ancillary Care Services Provider Credentialing and Re-credentialing Requirements	MP CR 701
Attachment A: Credentialing Verification Sources used by Partnership HealthPlan of California for Ancillary Providers
Attachment B: Non Medical Transportation Attestation
Delegation of Credentialing and Re-credentialing Activities	MP CR 800
Credentialing of Community Health Worker(CHW) Supervising Providers	MP CR 11
Supervising Provider Attestation for Community Health Workers
Credentialing of Independent and Private Duty 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
Registered Pharmacists for AB1114 Credentialing	MP CR 13 D
Pharmacy Provider Assessment Criteria	MP CR 14
Doula Credentialing and Re-credentialing Criteria	MP CR 15
Doula Attestation
Lactation Consultant Credentialing Policy	MP CR 16
Standards for Contracted Primary Care Providers	MP CR 17
Primary Care Provider Criteria Form
Example of CME Curriculum for Physicians Trained in Emergency Medicine, who are Seeking to do Primary Care for Children
Skilled Nursing Facility Providers (SNFs) Credentialing Policy	MP CR 19
Partnership Provider Contracts	MP PR 200
Provider Enrollment Status Guidelines	MP PR 203
Partnership Annual Physician Satisfaction Survey	MP PR 207
Partnership Provider Termination or Change in Location Information	MP PR 208
Provider Change Form
Provider Contract Termination Form
Provider Site Closure Form
Provider Network/Subcontractor Contract Terminations and Facility De-certifications and Suspensions	MP PR 209
Provider Grievance	MP PR-GR 210

Please Direct Questions To:

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

Section 4: Provider Relations

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Table of Contents - Medi-Cal