ACEs Provider Attestation Data Request Form

Medi-Cal providers must attest to having completed a certified ACEs Aware core training in order to bill Medi-Cal for conducting qualified ACE screenings. The list of these providers is now available to the public upon request. Interested parties may submit a request for the list of eligible Medi-Cal providers that have completed a certified ACEs Aware Core Training by completing the form below.

If you are a provider interested in completing the ACEs Provider Training Attestation Form, please visit the Medi-Cal website

 

female doctor smiling at young patient

Medi-Cal providers must attest to having completed a certified ACEs Aware core training in order to bill Medi-Cal for conducting qualified ACE screenings. The list of these providers is now available to the public upon request. Interested parties may submit a request for the list of eligible Medi-Cal providers that have completed a certified ACEs Aware Core Training by completing the form below.

If you are an eligible provider who has completed the certified training, please fill out the ACEs Provider Training Attestation Form on the Medi-Cal website.  

The Department of Health Care Services will release upon request First Name, Middle Initial, Last Name, National Provider Identifier (NPI), and Type of Provider (delivery system) as well as whether that provider opted-in to the ACEs Aware Provider Directory and all associated Provider Directory information (type of provider, service address, etc.). Please complete the data request form below.

Note: If you are a Medi-Cal provider who has completed a certified ACEs Aware Core Training, please fill out the ACEs Provider Training Attestation Form on the Medi-Cal website. Please also consider joining the ACEs Aware Provider Directory where Medi-Cal patients can find ACEs Aware providers in California. You may also confirm your attestation status by emailing info@ACEsAware.org or by completing the form below.