Overview

• The CenCal Health Directory
• Glossary
• Website Guide
• Quality of Care
• Contract Definitions
• Education and Training
• Credentialing and Recredentialing Standards
• Primary Source Verification
• Access to Care Standards
• Synopsis of Utilization Management Process
• CenCal Health Facility Audits
• HEDIS Process
• 2008 Quality Assessment and Improvement Program
• 2008 Quality Improvement Committee Structure
• Fraud Reporting
• Instructions for Completing a Fraud or Abuse Form
• Suspected Fraud or Abuse Referral Form for Member
• Suspected Fraud or Abuse Referral Form for Provider

Primary Care Provider/ Referral Provider Obligations

• PCP and Referral Provider Obligations Introduction
• Summary of Referral Physician Duties
• Notification of Practice Changes
• Notification of Practice Changes Form
• Capitation
• Case Management Protocols
• Care Management Referral Form
• Care Management Fillable Form
• PCP Incentive Program Protocols
• Reassignment Requests via the Web
• Santa Barbara CCS Protocols
• San Luis Obispo CCS Protocols
• CHDP Services
• Initial Health Assessment
• Adult Preventive Services
• Pediatric Preventive Services
• Recommendations for Preventive Pediatric Health Care
• Adult Immunization Schedule
• Pediatric Immunization Schedule
• Specialty Mental Health Services
• Physician Consultation Services for Behavioral Health
• ADMHS Referral Form
• PBH Referral Form
• Diabetes SMART Add/Remove Member Form
• After Hours Primary Care Provider List
• Inpatient Readmission Initiative Protocols

Allied Provider Obligations

• Allied Health Provider Obligations Information
• Case Management Concept for Allied Health Providers
• Protocols for Acupuncture
• Protocols for Audiology
• Protocols for Chiropractors
• Protocols for Diabetes Educators
• Protocols for Home Health
• Protocols for Hospice
• Protocols for Laboratories
• Protocols for Lactation Consultants/Educators
• Protocols for Nutrition Educators
• Protocols for Occupational Therapy
• Protocols for Opticians
• Protocols for Optometry
• Protocols for Physical Therapy
• Protocols for Speech Therapy
• Protocols for Transportation: Emergency Medical
• Protocols for Transportation: Non-Emergency Medical
• DME Provider Obligations
• Protocols for DME
• DME Quick Reference Guide
• Protocols for Medical Supplies
• Protocols for Incontinence Supplies (Effective 10/1/11 - 2/29/12)
• Protocols for Incontinence Supplies (Effective 3/1/12)
• Protocols for Hearing Aids
• Protocols for Orthotics & Prosthetics

Hospital Provider Obligations

• Hospital Provider Obligations Information
• Authorization
• Excluded Services
• Payment Procedures
• Service Obligations of the Hospital
• Utilization Management Protocols for SBHI & SLOHI
• Utilization Management Protocols for HF, HK, PP2, IHSS
• Santa Barbara CCS Protocols for Hospitals
• San Luis Obispo CCS Protocols for Hospitals

Contract (We have provided this section as a place to store your contract)

Policies and Procedures

• Introduction to Policies & Procedures
• 100-2300-A Fraud, Waste and Abuse Identification, Reporting and Investigation
• 100-7009-A Implementation of Deficit Reduction Act of 2005 Requirements
• 500-3002-C  Access to Care
• 300-1000-K Member Grievance System
• 500-2010-H Provider Credentialing Policy
• 400-4009-H Peer Review Process
• 400-4004-M Medi-Cal Facility Site & Medical Record Quality Improvement Program
• 500-3011-F Provider Grievance System    Provider Grievance Form
• 400-2000-F Coordination of Care
• 500-2008-C Continuity of Care
• 400-1022-B Clinical Utilization (UM) Criteria

Member Services

• Member Services Introduction
• Member Rights and Responsibilities - English
• Member Rights and Responsibilities - Spanish
• Member Grievance Form SBHI & SLOHI - English
• Member Grievance Form SBHI & SLOHI - Spanish
• Member Grievance Form HF,HK, PP2, IHSS - English
• Member Grievance Form HF,HK, PP2, IHSS - Spanish
• FAQs About Eligibility
• FAQs About Share of Cost (SOC)
• Language Services for CenCal Health Members
• Assessment Form for Physician and Staff Language Capabilities
• Instructions for Requesting Interpreter Services
• Quick Reference Guide for Language Services
• Language Line Quick Reference Guide
• Language Line Instructions
• Language "Point Chart"
• 12 Tips on Working Effectively with an Interpreter
• Checklist to Ensure Compliance with Cultural & Linguistic Requirements
• Cultural and Linguistic Resources
• Resources for Disabled and Special Needs
• Community Resources - SB North, SB South, SLO
• California Minor Consent Laws

Benefits Summary

• CenCal Health and State Medi-Cal
• PP2 Benefits Matrix
• Summary of IHSS Benefits & Covered Services Matrix
• IHSS Health Plan Benefits & Exclusions
• HF / HK Covered Benefits Matrix
• HF / HK Vision & Dental Benefits
• HF / HK Vision & Dental Carriers

RAFs

• e-RAFs
• Sample RAF
• FAQs About RAFs
• When RAFs Are Not Required
• Ordering RAFs
• RAF Guidelines
• RAF Instructions
• Bariatric Surgery Protocols
   

Authorization Requests

• Authorization for Medical Services and DME
• Authorization Guidelines for Hearing Aids
• Authorization Guidelines for Orthotics & Prosthetics
• Sample TAR
• TAR Diagram
• CenCal Health TAR Completion Instructions
• Ordering TARs
• Sample AR (Medical, Inpatient, LTC)
• AR Completion Requirements
• Ordering ARs
• Formulary Information
• MRF Process
• Sample MRF
• Sample PAF
• Specialty Pharmacy
• Specialty Pharmacy Order Forms (Restricted Area)
• RBM Fact Sheet

Claims

• Claims Billing
• Claims Correction Form
• General Guidelines for SBHI & SLOHI
• General Guidelines for HF, HK, PP2, IHSS
• Provider Payment SBHI & SLOHI
• Provider Payment HF, HK, PP2, IHSS
• Other Coverage

Facility Site & Medical Record Review

• Site Review Guidelines
• Medical Record Review Guidelines
• PARS Tool Attachment C
• Cidex Efficacy
• Cidex Log
• Glucometer Quality Control
• Hemacue Quality Control
• Hearing & Vision Screening
• Temperature Log Fahrenheit
• Temperature Log Celsius
• Medical Waste Mailback Sources
• Medical Waste Treatment
• Adult Immunization Record
• CDC Vaccine Abbreviations
• Vaccine Information Statements
• Facility Site Pre-Audit Checklist
• Sample Office P&Ps & Staff Training
• Sharps Injury Log
• Emergency Medication Dosage Chart
• Patient Referral Tracking Log
• TB Screening Questionnaire (English and Spanish)
   

Contracted Provider List (We have provided this section as a place to store your CPL)