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 Policies:

Policy: 7.1.1 Provider Credentialing and Continuous Monitoring

Procedure: Provider Credentialing and Continuous Monitoring Procedure

Credentialing Process Steps:

1. Submit required documentation to DHS-RMU-Credentialing DHS-RMU-Credentialing@sonomacounty.gov
   • 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. Some providers may require credentialing review or approval by Credentialing Committee and/or DHS Compliance. 
4. RMU will grant access to SmartCare once credentials have been approved and required SmartCare training is complete.

Required Documents for All Staff:

1. BHD-144 Staff Number and Smartcare Request Form.
2. Current resume / work history.
3. Credentialing Attestation Form
   1. Include attached Behavioral Health Credentialing Attestation Addendum (page 2) and Permissive Exclusion Attestation (page 3) as applicable for "yes" answers.
   2. Please provide an explanation for any yes answers.
4. National Provider Identification Number (NPI) with correct taxonomy code (see SMHS and DMC-ODS Billing Manual Appendix 1 – Taxonomy Codes)
   1. SMHS and DMC Billing Manuals can be found at https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx.
5. Contracted providers at organizations who do not complete the Pre Award Risk Assessment (PARA) process must submit a copy of pre-screening checks from the following databases:
   1. Social Security Death Master File (DMF).
   2. Office of Inspector General List of Excluded Individuals and Entities (OIG LEIE), System for Award Management (SAM), and DHCS Medi-Cal Ineligible Provider List (LSIP).
6. Contracted providers at organization who have not submitted a certificate of liability insurance at the time of contracting, must provide evidence of liability insurance.
7. Other documents may be required based on the credentialing provider type, please see credentialing procedure.

1. 1. Copy of current license, registration, certification, as required for the credentialing provider type.
   2. Provider Application and Validation for Enrollment (PAVE) registration is required for all licensed staff (registered and associates are excluded).
      1. https://pave.dhcs.ca.gov/sso/login.do
      2. Please enroll as Ordering, Referring, Prescribing (ORP)
   3. DEA License and CURES registration is required for all authorized prescribers.
      1. Controlled Substance Utilization Review and Evaluation System | State of California - Department of Justice - Office of the Attorney General

• National Provider Identifier Form
• BHD 170 Behavioral Health Division Credentialing Attestion
• MHS 700 SmartCare Electronic Signature Agreement
• BHD-144 Staff Number and Smartcare Request Form.

Credentialing Support Items:

DHCS PAVE Enrollment – How to Video