Join Our Network

Effective 1/1/2018 all Medicaid providers must be credentialed with the California Department of Health Care Services (DHCS) and enroll in the Medi-Cal program prior to submitting an application to join our network. 

In addition, DHCS requires that providers who have a certification or licensure to provide BHT or ABA services must fill out and submit the DHCS 6208 Medi-Cal Provider Agreement form along with their Cenpatico Join Our Network application.

Please proceed with the Cenpatico Join Our Network Application below

The DHCS Medi-Cal program requires that you fill out the DHCS 6208 Medi-Cal Provider Agreement form below. Please include it with your application to Join Our Network as you continue to fill out your request below.

Products Requested*
Please select all the products you would like included in your Agreement

Before you fill out the form below, please review the Checklist for credentialing, download all required documents, and fill them out completely. Once you have completed your documents, be sure to finish the form below and upload your documents

Before you fill out the form below, please review the Checklist for credentialing, download all required documents, and fill them out completely. Once you have completed your documents, be sure to finish the form below and upload your documents.

Please do not use dashes ("-")
Please enter your additional Facility/Agency NPIs that you are applying for delimited by a single comma. Please do not input Individual practitioner NPIs in this field.
If you have recently applied to enroll with DHCS, please include confirmation of your submitted application
Attach licenses, accreditations, certifications, enrollment letters, etc...
Attach other documentation such as Supervision forms, certifications, etc...