ACEs Provider Attestation Data Request Form

Entities that bill Medi-Cal may now submit a request for the list of providers that have completed the ACEs Aware training and are eligible to bill Medi-Cal. This attestation data should be used for program implementation purposes only.

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

Effective January 1, 2020, eligible Medi-Cal providers began receiving payment for screening children and adults for Adverse Childhood Experiences (ACEs). As of July 1, 2020, eligible Medi-Cal providers must self-attest to completing certified training to continue receiving payment for ACE screenings using the ACEs Provider Attestation Form.

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.  

Entities that bill Medi-Cal may now submit a request for the list of providers that have completed the ACEs Aware training and are eligible to bill Medi-Cal. This attestation data should be used for program implementation purposes only, such as confirming that your participating providers have submitted an attestation form and are eligible to bill Medi-Cal. The Department of Health Care Services will release the First Name, Last Name, and National Provider Identifier (NPI) to approved requestors. Please complete the form below.