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 February 1, 2025; last updated January 24, 2025)
- 2025 Prescription Drug Prior Authorization Criteria (effective February 1, 2025; last updated January 31, 2025)
- 2025 Prescription Drug Step Therapy Criteria (effective February 1, 2025; last updated January 24, 2025)
Provider Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory (last updated October 01, 2024)
- Part D Pharmacy Directory (last updated October 01, 2024)
| 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
- Member Language Assistance Services for Providers
- 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
- Corrected Claim Guidelines
- Claim Status Template (to be used when emailing multiple claims status inquiries)
- Paper Claim – Return Mail Notice
- Delegated Roster Template
- Quick Reference Guide
- Improving HEDIS Scores
- Homeless Provider Communication
- NPI Tax ID Flyer
- Waiver of Liability Statement
- Prescription Drug Authorization Request
- Prior Authorization Request Form
- Provider Claims Dispute Submission Form
- Provider Grievance Form
- Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
- California Pre-Service Injectable Drug Authorization Request
- 2018 Model of Care Summary
- 2014 Cultural & Linguistics Program
- PHP Provider Manual
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
- 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: February 10, 2025 @ 6:46pm