Provider Services

For accessibility issues, please contact Provider Services at 925-608-6790.

Directory

• Provider Directory

Provider Manual

• Provider Manual

Informing Materials (English/Spanish)

They are also available in Braille and audio. Call Access Line at 1-888-678-7277.

• Beneficiary Handbook | Spanish
  - (Large Print-English | Spanish)
• MHA58 - Beneficiary Grievance Review Request Form | Spanish
  - (Large Print-English | Spanish)
• MHA56 - Appeal or Expedited Appeal Request Form | Spanish
  - (Large Print-English | Spanish)
• MHA54 - Beneficiary Request for Change of Provider Form | Spanish
  - (Large Print-English | Spanish)
• MHA52 - Beneficiary Suggestion Form | Spanish
  - (Large Print-English | Spanish)
• Advance Directive | Spanish
  - (Large Print-English | Spanish)
• Continuity of Care | Spanish
  - (Large Print-English | Spanish)

Posters (English/Spanish)

• Beneficiary Rights:
  - Letter size (English | Spanish)
  - Ledger size (English | Spanish)
  
• Grievance/Change of Provider/Appeal:
  - Letter size (English | Spanish)
  - Ledger size (English | Spanish)
  
• Informing Materials poster:
  - Letter size (English | Spanish)
  - Legal size (English | Spanish)
  

Credentialing and Recredentialing

• Help Sheet
• Quick Reference Guide
• Application Checklist
• Taxonomy Codes
• NPI Registration & Taxonomy Alterations
• NPI Registration Changes
• MHA12 - ShareCare ID Request Form
• MHA22 - Credentialing/Privileging Form
• MHA22a - Facility Change Form
• MHA22b - Recredentialing Application
• MHA22c - SSN Consent Form
• MHA22d - Staff Termination Form
• MHA22e - Facility/Program Assignment Form
• MHA22f - Legal Name Change Form
• Sample Provider Signature Sheet

Scope of Practice

• Guidelines for Scope of Practice
• Scope of Practice Definitions

Certification/Re-certification

• SD/MC Provider Certification & Re-certification Protocol
• SD/MC Provider Certification & Re-certification Site Visit Preparation Guide
• CCMHP Individual/Group Site Review

PAVE and Medi-Cal Rx Enrollment

• PAVE Step-by-Step Guide
• NPI Registration and Alterations
• Medi-Cal Rx Step-by-Step Guide
• How to Update Primary Practice Address on NPPES
• Frequently Asked Questions

Network Adequacy Certification Tool (NACT)

• NACT Schedule
• NACT PowerPoint Training
• NACT PowerPoint Training (Printer Friendly)

ShareCare and Report Folder Access Request

• ShareCare and Report Folder Access Request Form

CBO ccLink Provider Portal

• CBO Provider Portal User Access Request Form

Beneficiary Protection Training

• Beneficiary Protection Training - PowerPoint
  - Beneficiary Protection Training (Printer Friendly)