Medi-Cal Credentialing in California: PAVE Enrollment, Managed Care Plans, Noridian Medicare and the 2026 Rule Change

Each line is its own application and its own timer. Where the right-hand column is empty of a number, the program does not publish one we could verify.

A "determination" under 14043.26 is not always an approval. The statute lets DHCS answer with provisional status, an incomplete notice, notice of a background check or pre-enrollment inspection, or a denial. Provisional status is what lets you bill.

California Medicaid provider enrollment runs through PAVE (Provider Application and Validation for Enrollment), the DHCS portal used for new fee-for-service applications, changes to an enrollment and continued enrollment. You create a PAVE user profile with an email address and password, then build the application inside it.

The provider-type list on the PAVE sign-in page shows how wide it is:

• Individual providers: physician/surgeon, podiatrist, chiropractor, psychologist, LCSW, LMFT, licensed professional clinical counselor, nurse practitioner, certified nurse midwife, certified nurse anesthetist, physical and occupational therapists, speech pathologist, audiologist, optometrist, acupuncturist, dentist, registered dental hygienists, doula and others.
• Group providers: a matching group type for most of those, plus a mixed group.
• Other health care businesses: physician-owned ambulatory surgical clinics, clinical laboratories, DME, pharmacies, transportation, community-based organizations and more.
• Non-physician medical practitioners enrolling under supervision (licensed midwife, nurse practitioner, physician assistant).
• Ordering, referring and prescribing (ORP) only applicants, covered below.

Two things to settle before you open the portal. Decide whether the doctor bills as an individual, joins a group's enrollment, or both, because the group and the rendering provider are separate applications. And confirm the license, NPI and practice address read identically on the Medical Board record, NPPES and the application, because the screening checks run against those outside records.

California put its enrollment timelines in statute, and the physician clock is shorter than the general one. These are the steps as Welfare and Institutions Code 14043.26 sets them out:

1. Receipt. DHCS must acknowledge a physician or physician group package within 15 days, and other packages within 30 days. The 30-day notice is also where DHCS tells an applicant if a moratorium bars its provider category.
2. First determination. Within 90 days for physicians and physician groups (subdivision (g)) or 180 days for other applicants (subdivision (f)), DHCS must grant 12 months of provisional provider status, send an incomplete notice, start background checks or a pre-enrollment inspection, or deny.
3. Incomplete notice. Every requested item has to reach DHCS within 60 days of the date on the notice. DHCS then has 60 days from the resubmission to grant, deny or start a check.
4. No complete resubmission in 60 days. The package "shall be denied by operation of law," and a currently enrolled provider can also lose the provider number at every business address.
5. Inspection or background check. DHCS notifies you when it finishes: provisional status, or a list of discrepancies with any remediation window.

Provisional status lasts 12 months and attaches to the business address the application covered; the provider number is used only at the approved locations unless the application disclosed services delivered elsewhere.

For years the strongest line in 14043.26 was the default: if DHCS missed the 180-day or 90-day deadline, the applicant received provisional status on day 181 or day 91. Senate Bill 164 (Stats. 2026, ch. 27), effective June 29, 2026, added subdivision (o), which switches that off for one year.

From July 1, 2026 through June 30, 2027, an applicant "shall not be granted provisional or preferred provisional enrollment status" because DHCS failed to act within the 90-day short-form period, the 90-day physician period, the 180-day general period, or the 60-day resubmission period. A missed deadline "shall not result in approval by default," and the application stays pending until DHCS issues a written determination. The subdivision becomes inoperative on July 1, 2027.

What that means in practice: during this window a late DHCS decision is simply late. Plan the start date around the written approval, not around the statutory day count, and keep the managed care applications moving in parallel so a slow state decision does not hold up every plan.

California has two faster lanes for qualifying physicians, both in 14043.26:

• Preferred provisional status (subdivision (d)). A physician with an unrestricted California MD or DO license, no adverse entries in the federal data bank, full privileges at an accredited general acute care hospital, and either a faculty appointment at a teaching or children's hospital or credentialing by a Knox-Keene licensed health plan or county organized health system (directly or through a credentialed group) can ask to be treated as a preferred provider. The request has to be marked on each application package. DHCS answers within 60 days, and approval carries up to 18 months of preferred provisional status.
• Short form for hospital-based physicians (subdivision (e)). A physician whose practice is based in a general acute care, rural general acute care or acute psychiatric hospital, with an unrestricted license and no adverse data bank entry, files a short form. DHCS acknowledges it within 15 days and enrolls the physician, or says why not, within 90 days; approval carries 12 months of provisional status.

The preferred-provider test is one reason we start the managed care credentialing early. A doctor already credentialed by a Knox-Keene plan meets one of its criteria, which can shorten the state step for the next application.

Medi-Cal managed care is organized county by county, so the plans you credential with depend on where the patient lives. The California Health Care Foundation's June 2023 county table of the plans scheduled for January 2024 shows the pattern; DHCS's own current list was not reachable when we updated this page, so confirm each county with the plan.

The same fact sheet says Kaiser Permanente moved to a single direct Medi-Cal contract with DHCS in 2024, covering 32 of California's 58 counties, and its table lists counties such as Butte, Glenn and Plumas with Partnership HealthPlan of California as the only Medi-Cal plan. In a single-plan county there is no second network to fall back on, so a stalled file with that one plan is a stalled county.

The "plan partner" arrangement in Los Angeles is the detail that trips practices up: a member can be assigned to L.A. Care but managed by Anthem Blue Cross or Blue Shield Promise, or to Health Net but managed by Molina. Being in network with the parent plan does not automatically put you in network with its partner, so check which entity holds the member and which one holds your contract.

Every Medi-Cal managed care network provider must be enrolled with the state, but PAVE is not the only door. Federal rule 42 CFR 438.602(b) requires the state to screen, enroll and periodically revalidate all managed care network providers, and says this "does not require the network provider to render services to FFS beneficiaries."

California plans read that two ways, and both are on the plans' own pages:

• CenCal Health (Santa Barbara and San Luis Obispo) says it has been required since January 1, 2018 to make sure new contracted providers are enrolled, accepts PAVE, and offers an internal enrollment pathway (Addendum N) that does not cover fee-for-service.
• San Francisco Health Plan says "DHCS requires all providers to enroll in Medi-Cal," offers a Medi-Cal-equivalent process of its own, and notes that credentialing happens only after a provider contract has been negotiated.

The 120-day rule is federal. Under 42 CFR 438.602(b)(2) a plan may sign you up while state enrollment is pending for up to 120 days, but must end the agreement the moment the state says you cannot be enrolled, or when one 120-day period runs out without enrollment. CenCal states it plainly: if the application is still not approved at day 120, the provider comes out of the network until it is.

Our default is to file PAVE anyway. It covers fee-for-service claims (including members not yet assigned to a plan), it travels with the doctor to every county, and it avoids redoing a plan-specific enrollment for each network.

A clinician who never bills Medi-Cal still has to be enrolled if their orders, referrals or prescriptions drive a Medi-Cal claim. Federal rule 42 CFR 455.410(b) requires every ordering or referring physician or other professional to be enrolled, and PAVE carries a separate "Order, Refer, Prescribe only (ORP)" path for physicians, nurse practitioners, physician assistants, psychologists, therapists and other listed types.

The practical case: a lab, imaging center, DME supplier or pharmacy bills Medi-Cal for a test or item your provider ordered. If the ordering provider is not enrolled, that claim can deny at the other entity, which then calls your office. Residents, locum tenens and telehealth clinicians are the usual gaps.

Federal rule 42 CFR 455.450 makes every state screen applications by categorical risk: limited (license verification and federal database checks), moderate (adds a site visit) and high (adds fingerprint-based criminal background checks). California's statute folds that in: under 14043.26(f)(4), DHCS may deny an application for failing to submit fingerprints or failing to pay an application fee as federal Medicaid rules require, and it may pause a file for background checks, pre-enrollment inspections or unannounced visits.

On the fee, 42 CFR 455.460 exempts individual physicians and nonphysician practitioners, providers already enrolled in Medicare or another state's Medicaid program, and anyone who already paid the fee to a Medicare contractor or another state. Institutional applicants pay. We could not read DHCS's own fee and risk-level pages on the day we updated this guide, so check the current amount and your provider type's risk level in PAVE before submitting.

Medi-Cal revalidation is called continued enrollment in California law, and it starts with a written DHCS notice to your provider category. Federal rule 42 CFR 455.414 sets the outer limit at five years for every provider type, and CenCal Health tells its network that PAVE enrollment "is valid for five years and must then be renewed." The continued-enrollment package goes through the same 14043.26 process as a new one, including the 60-day window to answer an incomplete notice; missing it can deactivate the provider number at every business address.

Moving is where California differs most from other states. An enrolled individual physician or dentist practice changing locations within the same county can file a change of location form instead of a full package (subdivision (b)). For other moves, a currently enrolled provider who applies for the new location may bill for services there once DHCS has received the application, and is treated as provisional until DHCS decides (subdivision (k)). Claims for services at the new address before DHCS receives the application can be denied, so file before the first visit there.

Check Medi-Cal enrollment status by logging in to PAVE and opening the application, and track the statutory notices against your submission date: a receipt notice within 15 days (physicians) or 30 days (others), then a determination by day 90 or day 180. Technical problems with the portal go to the PAVE help desk at (866) 252-1949, Monday through Friday, 8 a.m. to 6 p.m. Pacific, excluding state holidays.

Keep your own log next to the portal. Record the submission date, every notice and its date, and the 60-day resubmission deadline from any incomplete notice. During the July 2026 to June 2027 window, a passed deadline no longer changes the status on its own, so the log is how you know when to escalate. For a managed care plan, ask the plan for its credentialing status with the provider's name, NPI and tax ID, and the federal hub page on Medicaid provider enrollment covers how status checks work across states.

California's Medicare Administrative Contractor is Noridian Healthcare Solutions, the A/B MAC for Jurisdiction E, which also covers Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. Noridian's contact page (updated October 6, 2026) lists provider enrollment at 855-609-9960, option 3, with live support Monday through Friday, 6 a.m. to 5 p.m. Pacific. You file the CMS-855I or CMS-855B in PECOS and Noridian issues the PTAN; our Medicare provider enrollment guide covers which form fits which provider.

Noridian works to the processing standard CMS sets for every MAC in its Program Integrity Manual, chapter 10: an online application with no site visit, development request or fingerprinting is due 95% within 15 calendar days and 100% within 50. Medicare's retroactive window is narrow: under 42 CFR 424.521, physicians and nonphysician practitioners can bill for up to 30 days before the effective date (90 after a Presidentially declared disaster).

Retired railroad workers' Part B claims go to Palmetto GBA instead of Noridian. After the Noridian approval, request a Railroad Medicare PTAN with Palmetto's PTAN Lookup and Request Tool; no second CMS-855 is filed, and Palmetto asks you to allow up to 30 days.

Searches for "California credentialing requirements" mix teachers and nurses in with providers; this section answers only the provider meaning. For a physician to be credentialed by California payers, the core requirements are:

• License. An active license from the Medical Board of California (MD) or the Osteopathic Medical Board of California (DO). The preferred-provider and short-form lanes require the license to be free of revocation, suspension, probation or other limitation.
• NPI and taxonomy. An individual NPI, plus the group NPI the claims go out under, with the practice address current in NPPES.
• DEA registration for prescribers of controlled substances, and malpractice coverage with a current certificate.
• Hospital privileges where the plan or the 14043.26 fast lanes ask for them.
• CAQH ProView. Commercial plans and most Medi-Cal plans pull from it, and CAQH asks providers to re-attest every 120 days (CAQH quick reference). See CAQH explained.
• State Medi-Cal enrollment in PAVE or a plan's equivalent process, for any Medi-Cal network.

The commercial plans (Anthem Blue Cross, Blue Shield of California, Aetna, Cigna, UnitedHealthcare and others) each verify and approve on their own committee schedule. Our payer-by-payer credentialing hub has each one's steps.

The California files we see slow down for reasons that start with the provider's data, and the 60-day resubmission rule makes those mistakes expensive. The common ones:

• A missed incomplete notice. The 60 days runs from the date on the notice, not the day someone opened it. If the notice goes to a former office manager's email, the package can be denied by operation of law before anyone reads it.
• Addresses that disagree. The PAVE address, NPPES, the Medical Board record and CAQH should all read the same; a suite number on one and not the others is enough to cause a request for information.
• The wrong county assumption. Credentialing with a plan that does not operate in the patient's county, or with the parent plan when the member is assigned to its plan partner.
• Network-only enrollment that expires. A plan may carry you for 120 days while state enrollment is pending; when the state file stalls, you come out of the network.
• Billing at a new address too early. Claims for a new location before DHCS receives the application can be denied.
• Unenrolled ordering providers. A resident or telehealth doctor who orders labs without ORP enrollment creates denials somewhere else.
• Lapsed documents and an expired CAQH attestation, which stop every plan reading the profile at once.

The fix is unglamorous: check every field against the license, NPPES and CAQH before submitting, calendar every notice date, and follow up with each payer weekly, logging the representative, date and reference number.

For a California physician, gather the MD or DO license number and dates, individual and group NPIs, the IRS letter showing the legal name and tax ID, DEA registration, board certification if any, malpractice certificate, hospital privilege letters, practice locations and their county, ownership and managing-employee details for the group, bank information for payments, and a current CAQH profile. Add the Noridian approval letter once Medicare is done. Our intake checklist, with the secure way to send it, is on what we need from you to start credentialing.

If you are not sure which approvals let you bill, our explainer on what provider credentialing is separates credentialing, enrollment and contracting. Other state guides: Florida and Kentucky.

ClaimCarePro enrolls providers with Medi-Cal in PAVE, credentials them with the Medi-Cal managed care plans in their counties, files Medicare with Noridian, requests the Railroad Medicare PTAN, and handles CAQH and the commercial plans, all from one checked file with weekly, logged follow-up on every payer. Flat pricing: $250 per payer application per provider, CAQH setup $250, re-credentialing $250, maintenance $99 per provider per year, or the new-practice bundle at $1,750 per provider ($1,400 each additional provider on the same group and payers). Start credentialing now and get a secure start link within one business hour, or call (844) 772-8902. Details are on our provider credentialing services page, and upkeep after approval is on recredentialing.

Updated October 23, 2026. Each source was read on October 23, 2026 unless noted. Where a linked page changes, the linked page wins. Statutory summaries are not legal advice.

• California Welfare and Institutions Code section 14043.26, as amended by Stats. 2026, ch. 27 (SB 164), effective June 29, 2026: leginfo.legislature.ca.gov (receipt notices; 90-day and 180-day determinations; 60-day resubmission; preferred provisional and short-form lanes; change of location; new-location billing; subdivision (o) suspension of default provisional status July 1, 2026 to June 30, 2027)
• DHCS PAVE Provider Portal sign-in page: pave.dhcs.ca.gov (supported provider types including ORP; help desk (866) 252-1949)
• 42 CFR 438.602 (eCFR, current): ecfr.gov (state enrollment of managed care network providers; 120-day pending period)
• 42 CFR 455.410, 455.414, 455.450 and 455.460 (eCFR, current): 455.410, 455.414, 455.450, 455.460 (ORP enrollment, five-year revalidation, risk-based screening, application fee exemptions)
• CenCal Health, Provider Enrollment in Medi-Cal: cencalhealth.org (enrollment required since January 1, 2018; 120-day participation; PAVE valid five years)
• San Francisco Health Plan, Credentialing: sfhp.org
• California Health Care Foundation, Medi-Cal Explained: 2024 Managed Care Plans (published June 27, 2023): chcf.org (county plan table; Kaiser direct contract in 32 counties; L.A. Care and Health Net plan partners)
• Noridian JE Part B, Provider Contact Center (last updated October 6, 2026): med.noridianmedicare.com
• CMS, Medicare Program Integrity Manual, chapter 10 (read October 23, 2026 for our Medicare enrollment page): cms.gov
• 42 CFR 424.521 (read October 23, 2026 for our Medicare enrollment page): ecfr.gov
• Palmetto GBA, Enroll in Railroad Medicare (published January 13, 2026; read October 23, 2026 for our Medicare enrollment page): palmettogba.com
• Medical Board of California: mbc.ca.gov; Osteopathic Medical Board of California: ombc.ca.gov
• CAQH ProView Provider Quick Reference (read October 16, 2026 for our CAQH page): caqh.org

Not read, and therefore not stated: any page on www.dhcs.ca.gov (blocked to our reader and browser on October 23, 2026), so this guide quotes no DHCS processing average, current fee amount, risk-level table, All Plan Letter or current county plan list; and the provider pages of L.A. Care, Molina Healthcare and Health Net, which also blocked our reader. No Medi-Cal managed care plan credentialing timeline was found published.