Become a Ventura County Health Care Plan Provider
Contact us if you are interested in becoming a Plan provider by faxing a brief letter of interest to the attention of the Contracting Department to 805-981-5051.
Ventura County Health Care Plan Credentialing
To promote patient safety the Ventura County Health Care Plan (VCHCP) carefully evaluates and selects independent practitioners to provide care to its members. Practitioners are health care professional who are licensed, certified or registered by the state to practice independently and provide health care services to VCHCP members. VCHCP also contracts with organizational providers who are facilities or institutions that provide services for health plan members.
The Credentials Committee is responsible for credentialing, recredentialing and monitoring all healthcare providers qualifications. All credentialing and recredentialing are performed in a nondiscriminatory manner in accordance with National Committee for Quality Assurance (NCQA) standards and full compliance with government and state regulations. Practitioners are required to complete a California Practitioner Credentialing Application (CPPA) and its addendums (VCHCP also accepts the Council for Affordable Quality Healthcare (CAQH) applications). Organizational providers are required to submit the Organizational Provider/Facility application.
The complete application will need to be submitted to VCHCP via email or fax.
All providers must be qualified in accordance with current applicable legal, professional and technical standards and appropriately licensed, certified or registered. All Providers must have good standing in the Medicare and Medicaid programs. The Credentials Committee makes the decision to accept, retain, deny or terminate a practitioner's participation with VCHCP. The Credentials Committee does not make credentialing or recredentialing decisions based on an applicant's gender, age, race, ethnic/national identity, sexual orientation, type of patient in which a practitioner specializes or who specialize in conditions that require costly treatment.
Instructions for Completing the Application:
When applicable the credentialing/recredentialing process incorporates information from quality management such as site visits and member complaints. The provider must comply with these quality improvement activities. This information is utilized in determining the provider’s acceptability for participation and continued participation.
VCHCP will notify you of an incomplete application within 15 days of its receipt requesting the information to complete your application. Your incomplete application will be closed 60 days from receipt if the requested information is not received. Upon completion of the credentialing process, you will be presented to the Credentialing Committee for approval or denial. If denied you will be notified by certified mail. If approved, you will be notified by VCHCP’s Credentialing Department informing you of your effective date to see VCHCP members.
Providers have the right to review information obtained from any outside source and used in the credentialing process. If credentialing information varies substantially from that supplied by the practitioner, the practitioner will be notified by the Credentialing Department and offered the opportunity to correct erroneous information submitted by another party. VCHCP informs practitioners the status of their credentialing or recredentialing application upon request.
Practitioner applications are to include the most current copies of the following documentation with their submittal:
- Current, valid and unrestricted Professional License
- Current, valid, unrestricted DEA Certificate for prescribing controlled substance and applicable to the practice. If you do not have a DEA certificate provide an explanation why you do not have a current DEA certificate. If your DEA is pending provide clarification as to who will prescribe for you with your submittal.
- Providers must obtain current and adequate malpractice insurance coverage no less than $1million per occurrence to $3million in aggregate.
- Provide education/practice history from beginning of your education in your field of expertise up to your current practice location (must include months/years and account for any gaps greater than three months). Note this information may be submitted on your Curriculum Vitae (CV) indicate “see CV” on the application.
- List all clinical admitting privileges on the application. If you do not admit patients provide written admitting arrangements.
- If there are any medical malpractice claims settled in the amount of 50K or more and/or if you have been suspended or voluntarily resigned from a hospital or medical organization provide a written explanation of the occurrence.
- Board certification or board eligibility is required for new MDs and DOs applying after October 2012. If board eligible, applicant must become board certified after completion of training, at the first opportunity to take the certification exam based on the time frame specific to each specialty board.
- All attestation questions must be answered. Attestation must be sign and dated by the practitioner. Signature stamps are not accepted.
- Provide a current signed Release of Information to allow third party verification authorization. Signature stamps are not accepted.
- We also accept the CAQH application. However, the complete application (not the summary or CAQH number) will have to be provided to VCHCP along with the supporting documentation.
- VCHCP conducts site visits for new contracted provider sites.
Organizational/Facility Provider Application Instructions:
- Current facility state license; for facilities that do not have a state license provide the facility business license. For practitioner owned facilities also include the State Medical/Professional license(s).
- Professional staff roster and copies of the professional license for each staff member (not applicable to hospitals, skilled nursing facilities, home health or surgery centers).
- Operating licenses (etc. X-Ray, CLIA).
- Accreditation Certificates
- If not accredited provide the most recent site survey (CMS, DHCS, CDPH, other). If you do not have a site survey a survey will need to be conducted by the VCHCP.
b. Hospitals must provide current accreditation certificates.
- Current copy of the facility malpractice insurance coverage no less than $1million per occurrence to $3million aggregate.
Recredentialing is performed every 3 years and begins 6 months prior to the due date. For practitioners a prefilled recredentialing application will be sent to you to be completed. Review the application for incorrect information and provide missing information. Organizational providers will receive a blank application to be completed. Applications are to be returned with the supporting documentation and all signatures pages must be signed and dated.