How to get contracted with Santa Clara Family Health Plan as a doula

1. 1

   Get your Medi-Cal enrollment underway

   SCFHP’s Letter of Interest asks for your Medi-Cal provider number and lists Medi-Cal approval among the documents to send with it, so enroll through PAVE first (see how to become a Medi-Cal doula).

2. 2

   Send SCFHP a Letter of Interest

   SCFHP’s doula page says to download, complete and submit the Letter of Interest; SCFHP then contacts you to start the next steps. The form asks for your legal name and DBA, practice type (individual or group), tax ID, NPI, service address, Medi-Cal provider number and CAQH number. Send it with:

   • Your resume.
   • A W-9.
   • Your Medi-Cal approval.
   • A provider roster, if you’re a doula group.

   Email it to Contracting@scfhp.com or fax it to 1-408-376-3537. DHCS also lists Kram@scfhp.com for doula contracting and onboarding at SCFHP.

3. 3

   Set up CAQH for credentialing

   SCFHP credentials through CAQH ProView, a free online portal. Register at proview.caqh.org, authorize SCFHP to see your information, and complete every section. SCFHP wants your CAQH re-attestation date to be no more than 15 days old when you submit, and says credentialing typically takes 45 days from a complete application. A paper application is available on request.

   SCFHP’s credentialing checklist is written for licensed clinicians (license, DEA certificate, hospital privileges). Ask Provider Network Operations which items apply to doulas; expect professional liability insurance and five years of work history to be on the list.

4. 4

   Bill SCFHP electronically

   SCFHP’s Letter of Interest states that it requires all contracted providers to bill electronically, so set up a clearinghouse before your first visit. Doula claims follow Medi-Cal’s codes, diagnosis pairings and modifier XP (see our billing cheat sheet). DHCS lists ClaimsManagement@scfhp.com and ProviderServices@scfhp.com for doula billing, claims and payment questions.

   SCFHP covers doula services when recommended by a physician or licensed practitioner; under Medi-Cal’s standing recommendation that covers the standard package, and extra postpartum visits need a written recommendation.

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