Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
2025 Plan Publications
- 2025 Annual Notice of Changes (ANOC)
- 2025 Evidence of Coverage
- 2025 Comprehensive Formulary (effective October 1, 2025; last updated September 25, 2025)
- 2025 Prescription Drug Prior Authorization Criteria (effective October 1, 2025; last updated September 25, 2025)
- 2025 Prescription Drug Step Therapy Criteria (effective October 1, 2025; last updated September 25, 2025)
2026 Plan Publications
- 2026 Annual Notice of Changes (ANOC)
- 2026 Evidence of Coverage
- 2026 Comprehensive Formulary (effective January 1, 2026; last updated October 8, 2025)
- 2026 Prescription Drug Prior Authorization Criteria (effective January 1, 2026; last updated October 8, 2025)
- 2026 Prescription Drug Step Therapy Criteria (effective January 1, 2026; last updated October 8, 2025)
Provider Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory (last updated October 1, 2025)
- Part D Pharmacy Directory (last updated October 1, 2025)
| To report any errors in the PHP provider or pharmacy, please send an email to [email protected]. You may also report directory errors by calling Provider Relations at (888) 726-5411 between the hours of 8:00 am to 8:00 pm, Monday through Friday. |
Provider Publications and Documents
- PHP Provider Manual
- Quick Reference Guide
- Member Language Assistance Services for Providers
- Delegated Roster Template
- Improving HEDIS Scores
- Homeless Provider Communication
- NPI Tax ID Flyer
- Waiver of Liability Statement
- 2018 Model of Care Summary
- 2014 Cultural & Linguistics Program
Provider Forms
- Prescription Drug Authorization Request
- Prior Authorization Request Form
- Provider Claims Dispute Submission Form
- Provider Grievance Form
- California Pre-Service Injectable Drug Authorization Request
- Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
Provider Job Aids
- Home Health PPS Claims Job Aid
- Home Health OASIS Assessment Job Aid
- Home Health Notice of Admission (NOA) Job Aid
- CMS Glossary and Acronym List Job Aid
Clinical Guidelines
- Ablative Techniques as a Treatment for Barrett’s Esophagus
- Acupuncture
- Clinical Practice Guidelines & Preventative Health Guidelines
- Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists
- Kidney Transplantation
- Liver Transplantation
- Outpatient Cystourethroscopy
- Pancreas Transplantation and Pancreas Kidney Transplantation
- PHP Clinical Practice Guidelines Preventative Health Guidelines
- Services Reviewed Using IQ
- Services Reviewed Using NCDs & LCDs
- Small Bowel, Small Bowel/Liver and Multivisceral Transplantation
- Standards of Care for the Health of Transgender and Gender Diverse People
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
Page Updated: October 20, 2025 @ 5:16pm