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Update and report provider data

Report your agency's or clinic's data

Stay compliant by reporting required data monthly, annually and as necessitated by qualifying events.

All health care providers, participating or not participating in Medi‐Cal (“Individual”) are required to complete Attachment A: “Provider Ownership Interest and/or Managing Control Disclosure Statement” form. The purpose of this form is to determine if a contracted provider and/or network provider has ownership and controlling interests, disclosures related to business transactions, or disclosures related to persons convicted of crimes for the contractor (“Agency”).

You must notify BHSD of material changes to your organization. Complete and submit the Network Change Request when there is change in the following:

  • temporary closure of a program to referrals
  • permanent provider closure
  • ownership including mergers
  • organizational status
  • licensure, contract
  • key contacts
  • program location
  • re-certification
  • operating hours 
  • modes of service
  • your organization's ability of to provide the quantity or quality of contracted services in a timely way


Refer to the Network change request form completion instructions 
Last revised November 2023


The California Department of Health Care Services (DHCS) requires county-operated clinics and our contracted providers to submit provider data each month as part of the 274 network adequacy reporting. 

  • DateProcess
    15th of every month file, if holiday file will be prepared business day before

    Providers will log in to their web app account to access their respective provider data and provider directory to  review and update.

    23rd of every monthProviders will send email to [email protected] to notify that provider data is ready for review. 
    26th of every monthBHSD will notify the provider of errors in their files.
    29th of every monthProviders will log in to their web app account to correct errors and notify BHSD when updates are completed.


Apply to update your credentials

Any time your credentials change, be sure to initiate the credentialing process with us.

You are eligible to apply if you meet one or more of the following MHRS qualifying requirements:

  • Masters degree in the mental health field with two years of mental health clinical work experience. 
  • Bachelors degree in the mental health field with four years of mental health clinical work experience. 
  • Associates degree with six years of mental health clinical work experience. Two of the six years of required work experience must be completed after receiving your Associates degree.l

Download and complete the MHRS application. Follow the submission directions in the application.

You are eligible to request a professional license waiver if you are one of the following:

  • Psychologist intern or pre-licensed psychologist 
  • Out-of-state psychologist 
  • Out-of-state clinical social worker
  • Out-of-state marriage and family therapist 
  • Out-of-state professional clinical counselor

Download and complete the professional license waiver request form, then follow submission directions in the form.

When you are awarded a new license or certification, you will need to reinitiate the credentialing process with us to reflect your new credentials.