How to get contracted with Contra Costa Health Plan as a doula

1. 1

   Enroll with Medi-Cal through PAVE

   CCHP’s manual starts with Medi-Cal: doulas must apply for enrollment directly with Medi-Cal through PAVE, with all supporting documents. Once DHCS approves you, you’re on the list of PAVE-approved doulas that DHCS shares with CCHP, and CCHP may reach out to you. Steps: how to become a Medi-Cal doula.

2. 2

   Have the four prerequisites ready

   CCHP asks for these before it starts the process:

   • At least one Type 2 (organization-level) NPI. You submit claims under it. CCHP assigns members partly by distance, so if you work in several counties or locations it suggests registering more than one NPI.
   • A tax identification number.
   • Registration with the California Secretary of State to do business in California.
   • Proof of malpractice (professional liability) insurance.

   Most solo doulas start with only a Type 1 (individual) NPI. If you contract with CCHP you’ll need a Type 2 NPI for your business as well, which usually means setting up a business entity first.

3. 3

   Complete the contracting and credentialing packet

   Email CCHPcontracts@cchealth.org to start, or wait for CCHP’s contracting packet. It contains:

   Contracting forms

   • Prescreen form
   • DHCS Disclosure and Ownership form
   • Registration and Certification form
   • W-9
   • Reimbursement

   Credentialing forms

   • Doula credentialing application
   • Attestation

   You have to be both credentialed and contracted to be active in CCHP’s network, and CCHP says contracting may take one to three months.

   CCHP also requires the DHCS qualifications: 18+, adult and infant CPR (for example from the American Red Cross or American Heart Association), a HIPAA training attestation, and the training or experience pathway.

4. 4

   Sign up for ccLink and electronic payments

   • ccLink Provider Portal: submit claims, receive referrals and get electronic remittance advice. Complete the ccLink Access Agreement form (on CCHP’s Information for Providers page) and email it to CCHPPortalSupport@cchealth.org. Technical support: 925-957-7272.
   • Electronic payments: request them at EDIsupport@cchealth.org.
   • Eligibility: CCHP requires you to check eligibility and identity at every visit; claims for members who weren’t eligible aren’t paid. Check in the portal or on the Medi-Cal website.
5. 5

   Bill within 180 days, through Availity or ccLink

   • Filing limit: 180 days from the date of service (or from the primary payer’s EOB). Later claims are denied as untimely. You have 365 days to dispute how a claim was processed.
   • Electronic claims: CCHP uses Availity as its clearinghouse; register with Availity and send to payer ID CCHS. Or submit in ccLink.
   • Paper claims: CCHP Claims Department, P.O. Box 5122, Lake Forest, CA 92609.
   • Codes: CCHP’s manual reprints DHCS’s crosswalk and warns that claims are denied without a diagnosis code, or with one not paired with that procedure code. Enter it in box 21A of the CMS-1500 without a decimal point. Every line takes modifier XP, plus 93 or 95 for telehealth. Place of service for a home visit is 12.
   • Questions or disputes: ClaimStatus@cchealth.org or 877-800-7423, option 5.

   The full crosswalk is in our Medi-Cal doula billing cheat sheet.

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