Doula Application and Services Workflow

Step 1 – Doula Provider must meet eligibility requirements

• Experience
  Have you provided support to pregnant individuals and their families before, during, and after birth?
• In-person support
  Are you available to offer in-person services within your community?
• State requirements
  Do you meet the California Department of Health Care Services (DHCS) minimum requirements for doula providers?¹
• Medi-Cal enrollment
  Are you registered in the Medi-Cal Provider Application and Validation for Enrollment (PAVE) system?²

If you answered Yes to all requirements, proceed to Step 2.

_{¹ Medi-Cal Provider Manual: Doula Services (PDF)
² PAVE portal}

Step 2 – Complete and Submit the Doula Provider Participation Application

Complete and submit the applicable Doula Provider Participation Application to begin the application process.

• Doula Application – Health Net (PDF)
• Doula Application – CalViva Health (PDF)
• Doula Application – Community Health Plan of Imperial Valley (PDF)

Step 3 – Application Review Process

• After the application is submitted, you will receive an email from the Plan confirming receipt. This email will indicate that your application is added to the list for the next review cycle.
• Doula applications are reviewed and considered for selection based on eligibility criteria and Health Plan network needs.

Note: Submitting the Doula Provider Participation Application is not a guaranteed contract.

Decisions to contract are based on:

• Doula eligibility to be a contracted provider by meeting the above requirements.
• Health Plan network needs – We want to ensure that members have access to doula services consistently but want our doula network to have the volume to support long term programs.
• Ability to provide in person services in requested counties.

Note: Once you have applied, the application is kept on file. The Plan will continue to review all application requests, as any network changes or opportunities arise.

Step 1 – Verify member eligibility

The member must be active and enrolled in the Medi-Cal Plan. Confirm member eligibility for the month of service through either of the following:

• Provider portal (preferred method). Log in to the secure provider portal, then select Eligibility.
• Automated Eligibility Verification System: 800-456-2387
  The Automated Eligibility Verification System (AEVS) is available from 7:00 a.m. to 8:00 p.m., seven days a week. To access this automated network, providers will need their Medi-Cal Provider Identification Number (PIN).

If you are a provider who currently does not have access to the portal, refer to the below brochure for instructions on how to register:

• Save Time Navigating the Provider Portal brochure – Health Net (PDF)
• Save Time Navigating the Provider Portal brochure – CalViva Health (PDF)
• Save Time Navigating the Provider Portal brochure – Community Health Plan of Imperial Valley (PDF)

Step 2 – Doulas will contact members to schedule an appointment

Doula services support our members throughout the pregnancy, during labor and delivery, after birth, and up to one year postpartum. And doula services are available for pregnancies that end in stillbirth, miscarriage, or abortion.

Document doula services and put in the member medical record. Be prepared to present documentation to DHCS or Health Net, if requested. Use the form:

• Medi-Cal Doula Services Documentation of Doula Visit – Health Net (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – CalViva Health (PDF)
• Medi-Cal Doula Services Documentation of Doula Visit – Community Health Plan of Imperial Valley (PDF)

Any documentation format that meets DHCS documentation of services requirements will be accepted.

What Services Are Included

• A 90-minute initial visit
• Up to eight additional visits, including pre- and post-birth visits. All visits are limited to one per day, per member.
• Support during labor and birth
• Up to two additional visits after birth to discuss breast feeding, mental health, and other concerns. Visits last up to 3 hours.

Note: State Standing Order for Recommendation for Services:

The Department of Health Care Services (DHCS) issued a statewide standing recommendation that all Medi-Cal members who are pregnant or were pregnant within the past year would benefit from receiving doula services from a Medi-Cal enrolled doula provider. The recommendation fulfills the federal requirement for a physician or other licensed practitioner of the health arts acting within their scope of practice to provide a written recommendation for preventive services.

Step 3 – Collect Recommendation for up to nine (9) additional visits for Postpartum Care

Recommendation – Additional visits during the postpartum period require a recommendation. A doula may facilitate obtaining recommendation from any licensed practitioner for the member. Keep the recommendation form in the member file.

We will accept either Health Net or DHCS forms:

• Medi-Cal Member Recommendation for Doula Services – Health Net (PDF)
• Medi-Cal Member Recommendation for Doula Services – CalViva Health (PDF)
• Medi-Cal Member Recommendation for Doula Services – Community Health Plan of Imperial Valley (PDF)
• DHCS recommendation form (PDF)

Step 4 – Bill for doula services using claims/invoice form

Providers can bill through claims submission or invoice submission.

Important note: Authorization number is not a required field for billing.

Submit claims or invoice forms and supporting information to one of these options:

• Electronic data interchange (EDI) (preferred)
• Availity Essentials
• Bill by invoice – Please contact your assigned Point of Contact.
• Submit paper CMS-1500 (version 02/12) form for paper claims. Note: Using this method may take additional time.
  
  Refer to the Claims Procedures section for more information.
  • Address:
    Health Net – CalAIM Invoice
    PO Box 10439
    Van Nuys, CA 91410-0439
  • Fax: 833-386-1043

Billing training

To learn more about how to bill for doula services, refer to the Claims and Invoice for Providers training: CalAIM training > Required Onboard Trainings