How to get contracted with CenCal Health as a doula

1. 1

   Enroll in Medi-Cal through PAVE

   CenCal’s manual makes Medi-Cal enrollment a condition of joining: providers must be Medi-Cal (PAVE) enrolled where an enrollment pathway exists, and doulas have one. CenCal adds that its Provider Relations team will help you with enrollment if you have questions.

   Your services also have to be available to CenCal members in San Luis Obispo and/or Santa Barbara counties, and you accept CenCal’s reimbursement. Enrollment steps: how to become a Medi-Cal doula.

2. 2

   Submit a Provider Network Interest Form

   CenCal’s front door for every new provider is the Provider Network Interest Form on cencalhealth.org, or a call to Provider Relations at 805-562-1676 (psrgroup@cencalhealth.org). For doulas specifically, DHCS’s contact list names cslaughter@cencalhealth.org and dlopez@cencalhealth.org for contracting and onboarding.

   CenCal’s doula section points to a doula onboarding packet on its Credentialing Applications and Forms page.

3. 3

   Meet CenCal’s doula credentialing criteria

   CenCal’s doula criteria (manual section E23):

   • At least 18.
   • Proof of adult/infant CPR certification from the American Red Cross or American Heart Association.
   • An attestation that you’ve completed basic HIPAA training.
   • An NPI.
   • The training pathway (a certificate for 16+ hours across the five DHCS topics, and an attestation of support at three or more births) or the experience pathway (an attestation of five years as a doula in the last seven, and three letters from the last seven years, one from a licensed provider, a community-based organization or a DHCS-enrolled doula).

   And what CenCal asks of every provider joining (section C1):

   • The type of services you provide and your service locations.
   • A complete credentialing packet.
   • Proof of Medi-Cal (PAVE) enrollment.
   • A W-9 and all applicable NPIs.

   Keep records of three hours of continuing education every three years; CenCal can ask for them.

4. 4

   Understand CenCal’s recommendation and TAR process

   CenCal handles the recommendation as an authorization. A member’s clinician completes CenCal’s online Doula Services Recommendation Form, or submits a Treatment Authorization Request (TAR) in the Provider Portal (auth type “50-1 Medical”, the Doula box ticked, and the contracted doula chosen as the servicing provider). The recommending clinician doesn’t need to be in Medi-Cal or CenCal’s network.

   • CenCal automatically approves the standard package: an initial visit, up to eight more one-hour visits, labor and delivery or pregnancy-loss support, and two extended three-hour postpartum visits. The authorization runs 12 months from its start date.
   • Two doulas can be on the same auto-approved authorization, so one can back up the other.
   • Up to nine more postpartum visits need an additional TAR from the contracted doula, approved case by case on medical necessity.
   • Put the approved authorization number (CenCal’s “W#”) on your claim.

   If a client arrives with only a DHCS recommendation form, ask CenCal whether an authorization exists before the first visit: the claim needs the authorization number.

5. 5

   Bill in the CenCal Provider Portal with the right codes

   CenCal’s guide to a doula claim in its Provider Portal (CMS-1500):

   • Billing provider NPI: yours (or your doula group’s). Claim type: Physician.
   • Auth No.: the CenCal-approved authorization number.
   • Place of service: CenCal’s guide lists 02 labeled “member home”, 11 office and 25 birthing center. In the national code set, 02 is telehealth outside the patient’s home and 12 is home, so ask CenCal which it wants for in-home visits.
   • Procedure code with XP; for telehealth, 93 or 95 as the second modifier.
   • Units: 1 for every code except T1032, which takes up to 12 units per visit on one line (two visits, 24 units, per pregnancy, on separate days).

   Diagnosis codes: CenCal’s 2026 manual lists the current Medi-Cal set (Z32.2, Z32.3, Z33.1, Z39.0, Z39.1, Z39.2), with each procedure code allowed only certain ones. Its February 2025 quick reference guide still shows an older set (including Z33.2, O02.1 and O03.4); go by the manual. Our billing cheat sheet has the code-by-code pairings.

   Claim questions: CenCal Claims Services at 805-562-1038 or CenCalClaims@cencalhealth.org.

This guide summarizes CenCal 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 CenCal Health before you apply or bill.