Partnership HealthPlan Medi-Cal: PAVE, Carelon, and Availity Credentialing for Therapists

Who Partnership covers, and where Carelon fits

Partnership HealthPlan of California serves Medi-Cal members in 24 Northern California counties. Carelon’s California New Provider Orientation lists them on its Partnership line: Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and Yuba (Carelon CA orientation; Partnership: about). Placer County notes that several counties, including Placer, moved to Partnership on January 1, 2024 (Placer County).

Partnership lists Partnership Behavioral Health at (855) 765-9703, 24/7, and says mental health providers can call (207) 910-1267 for claims, credentialing, and contracting (Partnership: mental health services). Carelon has worked with Partnership for years; it was called Beacon Health Options until Beacon became Carelon Behavioral Health in March 2023 (NC Medicaid notice of the name change), which is why older Partnership documents say Beacon.

Before you apply

• An active, unrestricted California license (LMFT, LCSW, LPCC, or psychologist). Associates: see the associates section below.
• An individual NPI (Type 1), and a group NPI (Type 2) if you bill as a group.
• A complete, attested CAQH ProView profile with Carelon authorized to view it. See CAQH ProView for therapists.
• Malpractice coverage that meets Carelon’s requirements.
• An Availity Essentials account for your practice (Availity).
• A PAVE account, and your Medi-Cal enrollment application started or submitted. My full walkthrough is in Medi-Cal provider enrollment through PAVE.

Step by step: PAVE, then Carelon, then the portal

1. Enroll in Medi-Cal through PAVE. Partnership’s policy says it has made a business decision to require all eligible network providers to enroll in Medi-Cal through DHCS’s PAVE portal, and that it accepts the DHCS Provider Enrollment Division approval letter as verification (Partnership MPCR20). DHCS has an application page for LMFTs (DHCS: LMFT application information).
2. Save proof that you applied. Carelon’s join page says California Medi-Cal applicants need a Medicaid ID or proof of application through PAVE (Carelon: join our network). Download or screenshot the PAVE submission confirmation and application number.
3. Get your CAQH profile complete and attested, with Carelon authorized.
4. Register with Availity. Carelon says all new enrollment requests go through the Carelon Behavioral Health payer space in Availity.
5. Submit the Carelon enrollment request for Partnership’s Medi-Cal network, and include your PAVE proof (or Medi-Cal ID if you are already approved).
6. Respond quickly to Carelon’s requests for missing documents. Carelon sends the contract through a secure application once you are approved.
7. Sign the contract and note your effective date. Do not see Partnership members as in-network before it.
8. Watch the 120-day clock. Partnership allows a provider to participate for up to 120 calendar days while a PAVE application is pending with DHCS, and terminates the contract if DHCS denies the enrollment or the 120 days run out (Partnership MPCR20). Follow up on PAVE until you have the approval letter, and send it to Carelon.
9. Register for eServices, Carelon’s web portal for its California Medi-Cal plans, at providerportal.carelonbehavioralhealth.com (also reachable through Availity under payer ID BHOVO). The orientation says eServices lets you submit claims, verify eligibility, confirm authorization status, and check claim status (Carelon CA orientation; Carelon: provider portals).
10. Set up payments. Carelon is moving electronic payments to Zelis (Carelon: Zelis transition).

PAVE registration vs. the full Medi-Cal packet: what I could verify

The question I hear most is: “Do I need the whole Medi-Cal fee-for-service enrollment, or just a PAVE registration?” Here is what the official sources say, and what I have seen.

• You do not need to wait for Medi-Cal approval to apply to Carelon. Carelon accepts proof of application through PAVE.
• You do need a real Medi-Cal enrollment, not just a PAVE account. PAVE is now how Medi-Cal enrollment applications are filed, and Partnership requires its network providers to be enrolled in Medi-Cal and verifies enrollment monthly. DHCS’s APL 22-013 FAQ says plans must confirm a provider is enrolled before contracting, can let a provider participate for up to 120 days while enrollment is pending, and must end the contract if DHCS denies it (DHCS APL 22-013 FAQ; DHCS APL 22-013).
• Enrolling for your managed care plan does not mean you have to take straight fee-for-service Medi-Cal patients. DHCS’s FAQ says providers who enroll in Medi-Cal solely to participate in a managed care plan are not required to serve fee-for-service beneficiaries.
• The ordering, referring, and prescribing (ORP) only enrollment is not the right one for therapists who will bill. DHCS says ORP enrollment is for providers who do not bill Medi-Cal and does not allow reimbursement for services rendered (DHCS: ORP-only enrollment).

In my experience, Carelon only needed my PAVE application confirmation to move my Carelon application forward; I did not have to finish the Medi-Cal process before applying. But the PAVE enrollment still had to be approved for me to stay in Partnership’s network. Confirm with Carelon what it needs for your application, and confirm with DHCS which PAVE application type fits your license and practice.

After you are in: authorizations, initial visits, and claims

• Initial visits. Carelon’s Partnership manual (May 2022, written under the Beacon name) says members can access initial therapy sessions without prior authorization, that a PCP referral is not required, and that members get an initial six-month registration after a screening by a Carelon clinician (Carelon PHC manual). Check the current version for your contract before relying on it.
• Check eligibility and visits in eServices before every first session and regularly after that.
• Claims go to Carelon, not Partnership. The California orientation lists Availity with payer ID BHOVO for electronic claims and a paper claims address of PO Box 1862, Hicksville, NY 11802-1862. The old Partnership manual lists an Office Ally payer ID and plan ID; it is from 2022, so use current Carelon materials instead.
• Timely filing for Partnership is tiered in Carelon’s orientation: full allowance for claims filed within 6 months, then reduced reimbursement at 7 to 9 and 10 to 12 months, counted from the last day of the month of service. Check your contract and current manual.
• Members cannot be balance billed. Carelon’s California Medi-Cal provider addendum says providers may not bill Medi-Cal members for covered services, and that other health coverage is billed first (Carelon Medi-Cal addendum).
• Disputes go on Carelon’s California dispute form within 365 days from the date of denial, per the orientation.

For Medi-Cal billing basics, codes, and documentation, see how to bill Medi-Cal as a therapist. Bill for what you legitimately provide and document, and follow the payer’s authorization and documentation rules.

Associates and group practices

Associate billing must be confirmed in writing with each payer. Medi-Cal fee-for-service rules do allow associates (AMFT, APCC, ASW) to render non-specialty mental health services under a qualified supervising clinician, who signs the notes and is the billing provider (Medi-Cal provider manual). Partnership members, though, are managed care, and Carelon’s handbook says providers should not bill in their own name for services provided by an intern or another clinician. Which rule applies under your Carelon contract isn’t clear from public documents. Before an associate sees a Partnership member, get the answer from Carelon in writing. See Can associates bill insurance in California?.

Common mistakes

• Applying to Carelon with no PAVE application at all. Carelon asks for proof of PAVE.
• Filing an ORP-only PAVE enrollment when you plan to bill for therapy.
• Letting PAVE sit pending past Partnership’s 120-day window.
• Treating someone who needs specialty mental health services as a Carelon case instead of coordinating with the county.
• Billing Partnership directly instead of Carelon, or using the old Beacon payer details.
• Collecting payment from a Medi-Cal member for covered services.