Specialty Mental Health Services Provider Certification and Recertification
Behavioral Health Information Notices and Letters
10-04: MHP Self-certification Letter.pdf
Certification forms
DHCS 1735 Medi-Cal Certification Transmittal Form | Training Video
The purpose of the transmittal is to request the following transactions:
County-owned and operated provider - activate mode(s) or service, termination of a mode(s) or all services, address change and name change.
Contracted provider - activate a new provider, activate a mode(s) of service, and terminate mode(s) or all services, recertification, address change and name change.
DHCS 1736 County-Owned and Operated Certification Application Form | Training Video
The purpose of the form is for the County to submit an application for a new county-owned and operated provider.
DHCS 1737 County-Owned and Operated Provider Self-Survey Form | Training Video
The purpose of the Self-Survey Form is for the recertification of a county-owned and operated provider.
Resources
Contact Information
Contract and Enrollment Review Division (CERD)
Department of Health Care Services
1500 Capitol Avenue, MS 2303
PO Box 997413
Sacramento, CA 95899-7413
