How to get contracted with Health Plan of San Mateo as a doula

1. 1

   Enroll in Medi-Cal through PAVE

   HPSM’s first step is Medi-Cal enrollment: providers must be enrolled with Medi-Cal to contract with HPSM. Its 2023 presentation adds useful context: a PAVE enrollment is valid for five years and works for every Medi-Cal plan; the application takes a few hours, and processing usually finishes within two months (up to 120 days).

   Steps: how to become a Medi-Cal doula.

2. 2

   Contact HPSM to apply

   HPSM’s 2023 provider article invited doulas to apply through an online application and to email Provider Services with questions. DHCS’s current contact list gives hpsmcontracting@hpsm.org and psinquiries@hpsm.org for doula contracting and onboarding. Email one of them to get the current application.

3. 3

   Complete HPSM credentialing, with liability coverage

   HPSM’s 2023 guidance describes credentialing as three things:

   • Complete HPSM’s credentialing application.
   • Show evidence of general liability or professional liability insurance. HPSM’s 2023 slides gave $100,000 per claim or $300,000 as the coverage needed; confirm the current minimum.
   • HPSM verifies your qualifications, practice history, education and training.

   You also need to meet DHCS’s doula qualifications (18+, adult/infant CPR, HIPAA training, an NPI, and the training or experience pathway), and keep evidence of three hours of continuing education every three years for HPSM or DHCS.

4. 4

   Sign HPSM’s contract

   The contract sets the services, reimbursement method and rates. Once it’s signed you’re listed in HPSM’s provider directory, which is where HPSM’s manual sends members looking for a doula, and you get access to HPSM’s network training.

5. 5

   Bill each visit, check eligibility each time

   • Eligibility: HPSM puts it on the doula to confirm the member’s Medi-Cal eligibility with HPSM for the month of service, and recommends checking at every visit because status changes affect claims.
   • Claims: submit a claim for each doula visit; HPSM calls its provider portal the most efficient method and has claim tutorials in its Provider Learning Lab. Use Medi-Cal’s doula codes, diagnosis pairings and modifier XP (see our billing cheat sheet). DHCS lists claimsInquiries@hpsm.org for doula claim questions.
   • Recommendations: HPSM’s 2026 manual says that thanks to a standing order, doula services don’t need a written recommendation. Care beyond the standard package needs a written recommendation from a physician or other licensed practitioner, who doesn’t need to be in Medi-Cal or HPSM’s network.
   • Documentation: dates, time and duration, the service provided, and your NPI, available to HPSM and DHCS.

   In 2023 HPSM announced it would contract with The Doula Network, an organization that helps doulas with PAVE, credentialing and claims, and said its doulas would be paid 150% of Medi-Cal rates. Ask HPSM whether that arrangement is still in place before you choose between contracting directly or through a group.

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