Behavioral Health Provider Credentialing
| Date: | June 25, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Applied Behavior Analysis (ABA) Providers |
| Type: | Procedural Update |
| Subject: | Behavioral Health Provider Credentialing |
| Business: | Medi-Cal Managed Care |
As of May 1st, 2025, Health Plan started credentialing Board Certified Behavioral Analyst (BCBA) providers, to be in compliance with National Committee for Quality Assurance (NCQA) Practitioner Credentialing guidelines. Below are the Frequently Asked questions:
Frequently asked questions
I have questions about my credentialing application, whom do I contact?
Please contact your direct credentialing contact person if you have already connected with one, and if not email: Credentialing1@hpsj.com
What is Health Plan’s credentialing approval timeframe?
The credentialing process for Behavioral Health providers is completed within 60 days of receipt of the completed credentialing application. Health Plan credentialing timeframe primarily hinges on the completeness of submitted applications. Health Plan will prioritize providers with 100% completed applications along with required paperwork.
How often are the providers being re-credentialed?
The providers are recredentialed every 1-3 years based on committee approval.
What is the process for credentialing Licensed Qualified Autism Service (QAS) Providers?
Licensed QAS Providers such as Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, and Psychologists will go through the credentialing process and application, including the need for Medi-Cal enrollment.
What is the process for credentialing Board Certified Behavioral Analyst (BCBA)?
BCBA’s will go through the credentialing process and application. BCBA must enroll with Medi-Cal within 6 months once credentialed by Health Plan. As of May 5, 2025, there is a pathway for QAS providers (including BCBA at the individual and organizational level for Medi-Cal enrollment)
What do I need to do if providers leave my group or new providers join?
When provider (BCBA or Licensed Provider) leaves your group, please notify Health Plan via providerservices@hpsj.com
When a new provider (BCBA/Licensed Provider) joins your group, they will need to be credentialed by Health Plan to begin seeing members, please contact your direct credentialing contact person if you have already connected with one, and if not email: Credentialing1@hpsj.com
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
