Mental Health Provider Services
For accessibility issues, please contact Provider Services at 925-608-6790.
Provider Directory
- Provider Directory (The Provider Directory is updated weekly)
Provider Manual
Informing Materials
To request a printed copy of these materials for free, or in other formats, such as Braille or audio, call the Access Line at 1-888-678-7277. Requests will be processed within five (5) business days.
- Beneficiary Handbook.
Notice: The Beneficiary Handbook has changed effective January 1, 2024. - MHA58 Beneficiary Grievance Review Request Form
- MHA56 Appeal or Expedited Appeal Request Form
- MHA54 Beneficiary Request for Change of Provider Form
- MHA52 Beneficiary Suggestion Form
- Advance Directive
- Continuity of Care
Posters
- Beneficiary Rights:
- Grievance/Change of Provider/Appeal:
- Informing Materials poster:
Materiales Informativos
Para solicitar una copia impresa de estos materiales de forma gratuita o en otros formatos, como Braille o audio, llame a la Línea de Acceso al 1-888-678-7277. Las solicitudes se procesarán dentro de los cinco (5) días hábiles.
- Manual del Beneficiario. El Manual del Beneficiario ha cambiado a partir del 1 de enero de 2024.
- MHA58A Formulario de solicitud de revisión de quejas del beneficiario
- MHA56A Formulario de solicitud de apelación o apelación acelerada
- MHA54A Formulario de solicitud de cambio de proveedor del beneficiario
- MHA52A Formulario de sugerencia de beneficiario
- Advance Directive
- Continuidad del cuidado
Carteles/Afiches
- Derechos del Beneficiario:
- Queja/Cambio de proveedor/Apelación:
- Afiche de materiales informativos:
Credentialing Forms
- MHA12 - ShareCare ID Request Form (Required for all providers)
- MHA22 - Credentialing/Privileging Form (Required for all providers)
- MHA22c - SSN Consent Form (Required for all providers)
- MHA22g - CCMHP Peer Reference Form (For MDs, DOs and NPs ONLY)
- MHA22h - 274 Report Provider Information Form (Required for all providers – To be completed by Manager/Supervisor)
- Credentialing Packet (Forms combined - MHA12, MHA22 & MHA22c ONLY)
Recredentialing Forms
- MHA22b - Recredentialing Application (Required for all providers)
- MHA22h - 274 Report Provider Information Form (Required for all providers – To be completed by Manager/Supervisor)
Legal Name Change/Facility Change/Termination
- MHA22a - Facility Change Form
- MHA22d - Staff Termination Form
- MHA22e - Facility/Program Assignment Form
- MHA22f - Legal Name Change Form
Credentialing and Recredentialing Resources
- Help Sheet
- List of Accepted Taxonomy Codes
- NPI Registration & Taxonomy Alterations
- NPI Registration Changes
- Sample Provider Signature Sheet
Scope of Practice
- Guidelines for Scope of Practice:
- Scope of Practice Definitions
Certification/Re-certification
- SD/MC Provider Certification & Re-certification Protocol
- SD/MC Provider Certification & Re-certification Site Visit Preparation Guide
- CCMHP Individual/Group Site Review
PAVE and Medi-Cal Rx Enrollment
- PAVE Step-by-Step Guide
- NPI Registration and Alterations
- Medi-Cal Rx Step-by-Step Guide
- How to Update Primary Practice Address on NPPES
- Frequently Asked Questions
Network Adequacy Certification Tool (NACT)
- Monthly 274 Provider Network Data Reporting Guide – To request a copy, please contact Provider Services at 925-608-6790.
- NACT Schedule
- NACT PowerPoint Training
- NACT PowerPoint Training (Printer Friendly)