Provider Credentialing

The following guidelines are intended to inform providers regarding the process for credentialing and re-credentialing. BHD-DHS Leadership, Credentialing Committee, and Quality Improvement Manager may require additional documentation or amendments to the process as necessary to ensure regulatory compliance.

Sonoma County Procedures and Additonal Resources:

7.1.1 Provider Credentialing and Continuous Monitoring

Provider Credentialing and Continuous Monitoring Procedure (update in-process)

Appendix 1 - Taxonomy Codes DMC-ODS-Billing-Manual-08-22

 Appendix 1 - Taxonomy Codes SMHS Billing Manual May 2024

Credentialing Process Steps:

1. Submit required documentation to DHS-RMU-Credentialing DHS-RMU-Credentialing@sonoma-county.org
   • Missing or incomplete documents will result in delays!
2. Revenue Management Unit (RMU) will collect documents, coordinate with Quality Improvement to approve credentials, and send required SmartCare training to the staff member.
3. Quality Improvement will review required documentation and coordinate with RMU to get clarifications, missing documentation, or form updates.
4. Some providers may require credentialing review or approval by Credentialing Committee and/or DHS Compliance. 
5. RMU will grant access to SmartCare once credentials have been approved and required SmartCare training is complete.

Documentation Requirements for All Staff:

1. Staff Request Form 
2. Copy of current license, registration, or certification based on provider type.
3. Diploma or certified copy of transcripts.
4. Current resume / work history.
5. Contractor Attestation Form
   • Any prior convictions require explanation of conviction history and additional Permissive Exclusion Attestation.
   • Provide evidence of any sanctions or limitations on provider’s license.
   • Evidence of any history of liability claims filed against the provider.
6. Copy of pre-screening checks from:
   • Death Master File Index,
   • OIG LEIE, SAM, and Medi-Cal Ineligible Provider List.
7. National Provider Identification Number (NPI) with correct taxonomy code.
   • See Appendix 1 – Taxonomy Codes in the SMHS and DMC-ODS billing manuals for list of appropriate NPI for each provider type
   • SMHS and DMC Billing Manuals can be found at https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx
8. Other documents may be required based on the credentialing provider type, please see credentialing procedure.

• • Other Qualified Providers (OQP) and Graduate Student Interns require submission of a job description and supervision plan.
  • Medi-Cal Rx and CURES registration is required for all Physician, Psychiatrist, Nurse Practitioner, and Physician Assistants.
    • Medi-Cal Providers | Home
    • Controlled Substance Utilization Review and Evaluation System | State of California - Department of Justice - Office of the Attorney General
  • Provider Application and Validation for Enrollment (PAVE) registration is required for all licensed staff (registered and associates are excluded).
    • https://pave.dhcs.ca.gov/sso/login.do