How to get contracted with CalOptima Health as a doula

1. 1

   Enroll with Medi-Cal

   CalOptima’s contracting page lists Medi-Cal enrollment among its general requirements and asks for proof of it in your Letter of Interest. Doulas enroll through DHCS’s PAVE portal: see how to become a Medi-Cal doula.

   That page also lists requirements that clearly aren’t written for doulas (board certification, Medicare enrollment, hospital privileges). Don’t let them stop you; ask CalOptima’s doula team which apply.

2. 2

   Work out which networks your clients are in

   CalOptima’s member flyer spells out how members find a doula:

   • Members in CalOptima Health Community Network (CCN) or CalOptima Health Direct use CalOptima’s Find a Provider directory or Customer Service (1-888-587-8088).
   • Members in any other health network ask that network for its list of contracted doulas. The network’s phone number is on the back of the member’s ID card.

   For you, that means a CalOptima contract reaches CCN and Direct members, while members assigned to networks such as AltaMed, Prospect, HPN-Regal or Optum are reached through those networks. Check the ID card (or run an eligibility check) to see which network a client belongs to before you take them on.

3. 3

   Contact CalOptima’s doula team

   DHCS’s plan contact list gives Doula@caloptima.org and aramos@caloptima.org for doula contracting and onboarding at CalOptima. Start there, and ask whether doulas use CalOptima’s standard Letter of Interest.

   CalOptima’s standard process for new providers is a Letter of Interest emailed to ProviderOnboarding@caloptima.org, including:

   • Your legal name and DBA, if any.
   • Your NPI.
   • The services you provide and your service addresses.
   • Proof of Medi-Cal enrollment.
   • A W-9.
   • Your administrator’s contact information.

   CalOptima’s general requirements also mention an eCredentialing application, an Offshore Attestation, an Ownership & Disclosure form, and insurance (including professional liability of $1M per incident / $3M aggregate and cyber coverage). Those are written for all providers; ask the doula team which apply to a doula and what limits it expects.

4. 4

   Contact the health networks you want to serve

   DHCS publishes a doula contact for each of these CalOptima health networks. Each sets its own contracting and credentialing steps, so ask each one what it needs:

   Health network	Doula contact (per DHCS)
   AltaMed	cmoffatt@alturamso.com
   Prospect Medical Group (AMVI Care, Prospect, UCMG)	david.truong@prospectmedical.com, 562-646-3733
   CHOC	providerrelations@choc.org
   FCMG	marisha.hassan@coniferhealth.com
   HPN-Regal	izavala@regalmed.com, 714-539-3100 ext. 1101264
   Noble	dvalero@healthsmartmso.com
   Optum Network (Monarch HealthCare), billing contacts only	PRNorth@optum.com, PRSouth@optum.com

   Bill the entity you’re contracted with for that member: a member assigned to a health network is usually billed to that network, not to CalOptima. Confirm the claims address and payer ID with each network.

5. 5

   Bill without prior authorization for the standard package

   • CalOptima tells members they can reach out to any doula in their health network to start, and no prior authorization is needed for the standard package (an initial visit, eight more, labor and delivery or pregnancy-loss support, and two extended postpartum visits under DHCS’s standing recommendation).
   • Up to nine additional postpartum visits need a recommendation from a doctor or other licensed provider, noted in the medical record or on CalOptima’s Doula Recommendation Form (linked from its benefits page). DHCS’s standing recommendation can’t be used for these.
   • Claims follow Medi-Cal’s doula codes, diagnosis pairings and modifier XP. See our billing cheat sheet.

This guide summarizes CalOptima Health’s published material for convenience and is not billing or legal advice. Plans change their processes and contacts; follow your contract and confirm with CalOptima before you apply or bill.