Resources
Medi-Cal Provider Enrollment Through PAVE, Explained
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
Medi-Cal is California's Medicaid program, run by the Department of Health Care Services (DHCS). Getting paid for Medi-Cal members takes two separate things: a screened and approved Medi-Cal enrollment, usually filed with DHCS through the PAVE portal, and a credentialed contract with each managed care plan whose members you want to see. This guide explains both, the screening rules that decide how long the state step takes, and how the county plan models work.
Two Layers: State Enrollment and Plan Credentialing
The state layer is enrollment. The DHCS Provider Enrollment Division reviews applications submitted through PAVE, the Provider Application and Validation for Enrollment portal, and an approved enrollment establishes that you are licensed, not excluded and eligible to bill Medi-Cal fee-for-service.
The plan layer is credentialing and contracting. Most Medi-Cal members are enrolled in a managed care plan, and each plan verifies your credentials, decides whether to accept you, and issues its own contract and rates. DHCS treats screening and enrollment as separate from credentialing, which each plan runs as part of its own quality program.
California differs from most states in one way. Federal rules require every managed care network provider to be screened and enrolled, but DHCS lets plans do that screening themselves under delegated authority. A plan can enroll you through its own process or send you to DHCS, and either way it must confirm you are enrolled before it contracts with you. A plan screening you itself must decide within 120 days and may let you participate provisionally during that time. If you also want to bill fee-for-service Medi-Cal, file in PAVE, which DHCS recommends wherever a fee-for-service pathway exists.
The PAVE Enrollment Application
PAVE is a web portal, so there is no paper package for most provider types. Provider types not yet supported in PAVE can request a paper application from the Medi-Cal Provider Service Center. For an individual practitioner the PAVE application asks for:
- Identity and licensing: California license and NPI, which DHCS verifies, including licenses held in other states
- Service location and pay-to and mailing addresses, which should match the license and the practice's tax records
- The supporting documents PAVE requests for your provider type, uploaded with the application
- Disclosure of every person with a 5 percent or greater ownership or control interest, managing employees, and any criminal, licensing or program history
- For groups, the group's own enrollment plus an affiliation for each rendering practitioner
Practitioners who only order, refer or prescribe, including practitioners at FQHCs, rural health clinics, community clinics and Indian health facilities who are identified on claims, enroll on the shorter Ordering, Referring and Prescribing (ORP) application. The PAVE help desk is at (866) 252-1949, weekdays 8 a.m. to 6 p.m. Pacific, and the Medi-Cal Provider Service Center is at (800) 541-5555. Pay-to and mailing address changes after approval go through a PAVE supplemental changes application, which the Provider Enrollment Division must approve.
Application Fees
Individual practitioners and physician and non-physician practitioner groups do not pay an application fee. Other applicants, such as facilities, clinics, agencies and suppliers, pay the federal provider enrollment application fee set by CMS each year. For applications submitted in calendar year 2026 the fee is $750, up from $730 in 2025, and the year is set by the PAVE submission date. DHCS accepts the fee only by electronic funds transfer through PAVE. A provider that has already paid the fee to Medicare or another state's Medicaid program for the same period can document that payment rather than paying twice.
Risk Levels: Who Gets a Site Visit, Who Gets Fingerprinted
Federal Medicaid rules at 42 CFR Part 455 require each state to screen providers according to a risk level assigned by provider type, and DHCS uses those federal categories. The risk level is the single biggest driver of how long the state step takes.
| Risk Level | Typical Provider Types | Screening |
|---|---|---|
| Limited | Physicians, nurse practitioners, therapists, psychologists, LCSWs, physician groups | License verification, including other states, plus federal and state database checks before and after enrollment |
| Moderate | Several agency and supplier types designated by CMS | Everything in limited, plus a pre-enrollment site visit and post-enrollment visits at least every five years |
| High | Newly enrolling home health agencies and DME suppliers, plus providers raised to high risk | Everything in moderate, with post-enrollment visits every three years, plus fingerprint-based criminal background checks for every person with a 5 percent or greater ownership interest |
A provider moves to high risk after a payment suspension based on a credible allegation of fraud, an existing Medicaid overpayment, or an exclusion in the previous 10 years. DHCS has also named clinical labs, hospice, transportation, pharmacies and home health agencies as elevated-risk categories in its current revalidation plan, and every Medi-Cal provider is subject to unannounced onsite inspections. The typical individual practitioner gets limited risk screening with no visit and no fingerprints.
Revalidation
Federal rules require revalidation at least every five years. In 2026 DHCS submitted a revalidation plan to CMS that adds off-cycle revalidation through mid 2028, starting with DME, Drug Medi-Cal, clinical lab and transportation providers and then moving to elevated-risk types and providers without an NPI. The plan sets firm deadlines:
- 35 days from the DHCS notice to say whether you will revalidate or withdraw
- 70 days from the DHCS instructions to submit a complete application
- 60 days to correct any deficiencies DHCS finds
Missing the notice or the submission deadline results in automatic termination and deactivation, and withdrawing deactivates every associated service location. Managed care plans must screen revalidations for providers they enrolled themselves. Notices go to the address on file, so an old mailing address is the most common cause of a surprise termination.
The Medi-Cal Managed Care Plans
Which plans you can join depends on the county, because Medi-Cal managed care runs on different models in different parts of the state. Based on the DHCS county plan listings:
- County organized health systems, one main plan per county: CalOptima Health (Orange), CenCal Health (San Luis Obispo and Santa Barbara), Central California Alliance for Health (Merced, Monterey, Santa Cruz, San Benito and Mariposa), Gold Coast Health Plan (Ventura), Health Plan of San Mateo (San Mateo), and Partnership HealthPlan of California (24 northern counties, including Marin, Napa, Solano, Sonoma, Humboldt, Shasta, Placer and Yolo)
- Local public plans: L.A. Care Health Plan (Los Angeles), Inland Empire Health Plan (Riverside and San Bernardino), Alameda Alliance for Health, Contra Costa Health Plan, San Francisco Health Plan, Santa Clara Family Health Plan, Health Plan of San Joaquin (San Joaquin and Stanislaus), Kern Health Systems (Kern), CalViva Health (Fresno, Kings and Madera) and Community Health Plan of Imperial Valley (Imperial)
- Commercial plans with multi-county footprints: Anthem Blue Cross Partnership Plan, Health Net Community Solutions and Molina Healthcare of California, plus Blue Shield of California Promise Health Plan and Community Health Group Partnership Plan in San Diego
- Kaiser Permanente, which serves Medi-Cal members in many counties
Each plan takes a request through its own provider application, verifies credentials, often from your CAQH (now DataSpring) profile, and issues its own contract. Check the DHCS Medi-Cal Managed Care Health Plan Directory for your county before you apply, because plan line-ups change at contract renewals.
Typical Timeline, Start to Finish
- Document gathering and CAQH build or update: typically 1 to 2 weeks
- PAVE enrollment: DHCS has up to 180 days by statute, longer if the application is returned for correction
- Moderate or high risk types: longer, because site visits and fingerprinting are added
- Plan credentialing: typically 45 to 120 days per plan, run in parallel once you are enrolled
A practice that files in PAVE on day one and sends every plan request as soon as the enrollment is approved is typically billing its county plans within six to nine months. Have the CAQH profile attested and authorized for each plan before approval so nothing is waiting on you.
Where Medi-Cal Applications Go Wrong
- A service location or pay-to address that does not match the license or the W-9
- Ownership disclosure that leaves out an owner, an officer or a managing employee
- Nobody answering a DHCS deficiency notice in time, so the application is returned and the clock restarts
- A missed revalidation response window, which leads to automatic deactivation
- Applying to a plan that does not operate in the practice's county
- CAQH profile not authorized for a specific plan, which stalls that plan and only that plan
- An old mailing address in PAVE, so notices never arrive
How PECS Handles Medi-Cal
PECS prepares and submits the PAVE application, tracks it with DHCS, then files the managed care plan applications for your county as soon as the enrollment is approved, with regular follow-up to every payer and each contact logged to your reference number at pecs.health/status. Medi-Cal enrollment is $500 per provider and each managed care plan application is $200 per application per provider, both billed 50% at engagement and 50% at submission. CAQH (now DataSpring) build is $500 and update is $250. Ongoing maintenance at $100 per provider per quarter includes revalidation tracking so a DHCS notice never sits unanswered.
Frequently Asked Questions
How long does Medi-Cal provider enrollment take?
California law gives the DHCS Provider Enrollment Division up to 180 calendar days to act on a fee-for-service application, and the clock can run longer if the application is returned for correction. Moderate and high risk provider types take longer because site visits and, for high risk types, fingerprinting are added. Managed care plan credentialing is a separate step on top of that.
Do I need to enroll in Medi-Cal if I only want to join the managed care plans?
Yes, every Medi-Cal managed care network provider must be screened and enrolled. California gives plans two routes: the plan can screen and enroll you itself under authority delegated by DHCS, or it can send you to enroll with DHCS through PAVE. Either way the plan must confirm you are enrolled before it contracts with you, and DHCS recommends PAVE where a fee-for-service pathway exists.
What is the Medi-Cal application fee?
Individuals and physician and non-physician practitioner groups do not pay an application fee. Other applicants pay the federal application fee, which is $750 for applications submitted in calendar year 2026, up from $730 in 2025. DHCS accepts the fee only by electronic funds transfer through PAVE, and cashier checks only for paper applications. A provider that already paid the fee to Medicare or another state Medicaid program can document that payment instead.
Which providers get a site visit or fingerprinting in California?
DHCS screens by the federal risk levels in 42 CFR 455.450. Limited risk types, including physicians and most individual practitioners, get license and database checks only. Moderate risk types add pre- and post-enrollment site visits, and high risk types also require fingerprint-based criminal background checks of every owner with a 5 percent or greater interest. Post-enrollment site visits recur every five years for moderate risk and every three years for high risk.
How often do I have to revalidate with Medi-Cal?
Federal rules require revalidation at least every five years, and DHCS is running an off-cycle revalidation effort from 2026 into 2028. When DHCS sends a notice you have 35 days to say whether you will revalidate or withdraw, and then 70 days from the instructions to submit a complete application. Missing either deadline results in automatic termination and deactivation.
Which managed care plans serve Medi-Cal members?
It depends on the county. Medi-Cal managed care runs on several county models: county organized health systems such as CalOptima Health and Partnership HealthPlan of California, local plans such as L.A. Care and Inland Empire Health Plan, and commercial plans such as Anthem Blue Cross Partnership Plan, Health Net Community Solutions and Molina Healthcare of California. Kaiser Permanente also serves members in many counties. Each plan credentials separately.
What does an individual practitioner submit in PAVE?
PAVE is the DHCS online enrollment portal. A rendering practitioner enters identity and licensing details, the NPI, practice location and pay-to and mailing addresses, and full disclosure of ownership, managing employees and any adverse history, then uploads the supporting documents PAVE asks for and signs electronically. Practitioners at FQHCs, rural health clinics and similar clinics who need to be identified on claims enroll as Ordering, Referring and Prescribing (ORP) providers.
What does PECS charge for Medi-Cal enrollment?
Medi-Cal enrollment through PAVE is $500 per provider, billed 50% at engagement and 50% at submission. Each managed care plan application is $200 per application per provider on the same split, so a provider who wants the Medi-Cal enrollment and two plans in the county pays $900 in total. CAQH (now DataSpring) build is $500 and update is $250. Ongoing maintenance including revalidation tracking is $100 per provider per quarter.
Get an instant answer, or send it to our team and we will reply by email within one business day.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
By the PECS credentialing team, updated October 19, 2026.