Provider Credentialing Steps in Medi-Cal

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Provider Credentialing Steps in
Medi-Cal
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Provider Credentialing Steps in Medi-Cal
Provider credentialing is a process by which a
healthcare provider is verified to ensure they
meet the necessary requirements to provide
healthcare services to patients. It is important
to note that the credentialing process may take
several months, so it is best to start the
process early. The provider credentialing steps
in Medi-Cal are as follows 1. Complete the
Provider Enrollment Application In California,
the Provider Enrollment Application is the
process by which healthcare providers can enroll
in the states Medicaid program, known as
Medi-Cal. The enrollment process ensures that
providers meet the states qualifications for
participation and establishes a providers
ability to receive payment for services rendered
to Medi-Cal beneficiaries. The Provider
Enrollment Application process is managed by the
California Department of Health Care Services
(DHCS) and is designed to be completed online
through the Medi-Cal website. The application is
used for both initial enrollment and
re-enrollment, and the requirements and
documentation needed vary depending on the type
of provider. To begin the enrollment process,
providers must first register for a Medi-Cal
provider number. This number is used to identify
the provider and is required to submit claims for
payment. Once registered, providers can begin the
enrollment process by completing the online
application and providing all necessary
supporting documentation. The application
requires information about the providers
identity, practice location, medical specialties,
and services offered, as well as information
about the providers billing practices and
compliance with state and federal regulations.
Additionally, the provider must submit
documentation such as licenses, certifications,
and liability insurance information to support
their application.
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Provider Credentialing Steps in Medi-Cal

• The Provider Enrollment Application process can
  take several weeks to complete, and providers are
  encouraged to submit their application as soon as
  possible to ensure timely processing. Once
  approved, providers are issued a Medi-Cal
  provider number and can begin billing for
  services rendered to Medi-Cal beneficiaries. Its
  important to note that the Provider Enrollment
  Application process is a critical step for
  healthcare providers seeking to participate in
  the Medi-Cal program. Without enrollment,
  providers cannot bill for services rendered, and
  beneficiaries may not have access to necessary
  healthcare services.
• 2. Complete the National Provider Identifier
  (NPI) Application
• If you do not have a National Provider Identifier
  (NPI) when applying for Medi-Cal, you will need
  to complete an application for an NPI. Here are
  the steps you can follow
• Go to the National Plan and Provider Enumeration
  System (NPPES) website https//nppes.cms.hhs.gov/
  .
• Click on Create or Manage an NPI and select
  Apply Online.
• Read and agree to the NPI Terms and Conditions.
• Select Type 1 as the application type.
• Enter your personal information, such as name,
  date of birth, and social security number.
• Enter your business or practice location
  information.
• Enter your contact information, including email
  address and phone number.
• Select your taxonomy code, which identifies your
  specialty or area of practice.

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Provider Credentialing Steps in Medi-Cal

• Submit your application.
• Once your application is approved, you will
  receive your NPI number by email or mail.
• You will then need to provide your NPI number to
  Medi-Cal, either during the application process
  or after your enrollment is approved. This will
  ensure that you can be reimbursed for the
  services you provide as a Medi-Cal provider.
• 3. Submit Required Documentation
• You must submit supporting documentation such as
  your state medical license, malpractice
  insurance, DEA certificate, and other required
  documentation. You should follow these general
  steps
• Determine the required documents Medi-Cal has
  specific requirements for provider credentialing.
  You can find the list of required documents on
  the Medi-Cal website or by contacting the
  Medi-Cal provider enrollment unit.
• Gather the documents Collect all the required
  documents in advance to avoid any delays in the
  application process. Make sure that the documents
  are complete and accurate.
• Submit the documents You can submit the required
  documents by mail or online through the Medi-Cal
  provider enrollment portal. Follow the
  instructions provided by Medi-Cal to ensure that
  your submission is accepted.
• Follow up After you submit your documents, it is
  important to follow up with Medi-Cal to ensure
  that your application is processed in a timely
  manner. You can check the status of your
  application by logging into the provider
  enrollment portal or by contacting the Medi-Cal
  provider enrollment unit.

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Provider Credentialing Steps in Medi-Cal

• Respond to requests for additional information
  If Medi-Cal requires additional information or
  documentation, respond promptly to avoid any
  delays in the credentialing process.
• It is important to note that the credentialing
  process can take several weeks or even months to
  complete, so it is recommended to start the
  process as early as possible.
• 4. Background Check
• Providers must undergo a background check to
  ensure that they are in good standing with their
  state licensing board. Provider background checks
  are an important part of the Medi-Cal program.
  The purpose of these checks is to ensure that
  individuals who provide services to Medi-Cal
  beneficiaries are qualified and have no history
  of criminal or fraudulent activity that could
  compromise the quality of care provided to
  patients. The background check process includes a
  review of the providers criminal history,
  including any convictions, arrests, or pending
  charges. It also includes a check of the
  providers professional license status, education
  and training credentials, and any past
  disciplinary actions or sanctions.
• The California Department of Health Care Services
  (DHCS) is responsible for conducting provider
  background checks for Medi-Cal. DHCS uses a
  variety of sources to obtain information about a
  providers background, including the California
  Department of Justice, the Federal Bureau of
  Investigation, and other state and federal
  agencies. If a provider has a criminal history or
  other issues that may affect their ability to
  provide quality care to Medi-Cal beneficiaries,
  DHCS may deny their application to participate in
  the program or take disciplinary action against
  them.

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Provider Credentialing Steps in Medi-Cal
This can include revoking their provider
agreement, imposing fines, or suspending or
revoking their professional license. Overall, the
provider background check process is an important
part of ensuring that Medi-Cal beneficiaries
receive high-quality care from qualified
providers who are committed to providing safe and
effective services. 5. Credentialing
Verification The California Medicaid program
verifies your credentials, including proof of
education and training, licensure or
certification, work experience, and any other
qualifications that are relevant to their
practice. The California Medicaid program may use
various methods to verify these credentials,
including contacting the providers educational
institutions, licensing boards, and previous
employers. The program may also use online
verification services or databases to confirm the
providers credentials. The program may also
conduct site visits or audits to ensure that
providers are complying with program rules and
regulations. It is important for healthcare
providers to provide accurate and complete
information when applying for enrollment in the
California Medicaid program and to keep their
credentials up to date. Failure to do so may
result in denial or revocation of enrollment, as
well as potential legal and financial
consequences. 6. Enrollment Approval Once your
application has been reviewed, and your
credentials have been verified, you will receive
approval to participate in the California
Medicaid program.
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Provider Credentialing Steps in Medi-Cal
7. Contracting Once a provider has met all of
Medi-Cals contracting requirements, they must
sign a provider agreement with the program. This
agreement outlines the terms and conditions of
the providers participation in Medi-Cal,
including the reimbursement rates they will
receive for services provided to Medi-Cal
beneficiaries. Once a provider is contracted with
Medi-Cal, they can begin providing services to
Medi-Cal beneficiaries and submitting claims for
reimbursement. Medi-Cal reimburses providers at
rates that are typically lower than private
insurance, but providers can still see
significant patient volume and revenue through
their participation in the program. Legion
Healthcare Solutions is a leading medical billing
company providing complete billing and coding
including provider credentialing services. We
shared information about provider credentialing
steps in Medi-Cal, just for reference purpose
only. Kindly consider them as general guidelines
as credentialing requirements for Medi-Cal might
change from time to time. To connect with our
credentialing expert and know more about our
credentialing and enrollment services, call us at
727-475-1834 or email us at info_at_legionhealthcares
olutions.com.
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