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PHC California Policies & Procedures
PHC California is pleased to offer information about policies and procedures that apply to our Health Plan operations.
Policies & Procedures by Department
- Adults and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services
- Adult Preventive Services
- CalAIM Closed Loop Referrals for Community Supports and ECM
- CalAIM Community Supports Enrollee Identification
- CalAIM Discontinuation of ECM Service and Transition to Lower Level Care Management
- CalAIM ECM Service Member Identification
- CalAIM Enhanced Care Management Program and Core Service Components
- CalAIM Health Plan Responsibility for Administration of Community Supports
- Care Management of Enrollees Receiving Transitional Rent Community Support
- Chronic Care Management Program
- Community Health Worker
- Continuity of Care
- Initial Health Appointment
- Major Organ Transplants
- Mental Health Services
- Population Health Management Program
- Transportation Benefit
- CalAIM Timely and Non-standard Claims Submission Payments
- Claim Overpayments
- Claims Adjustments
- Claims Compliance Timeliness
- Claims Inventory and Pended Claims
- Claims Quality Control Monitoring
- Emergency and Non-Emergent Transportation
- Emergency Services
- Provider Dispute Resolution
- Provider Reimbursement
- State Supported Services, Family Planning and Proposition 56 Claims Processing
- Annual Risk Assessment
- Auditing and Monitoring
- Compliance and Anti-Fraud Plan
- Compliance Officer and MCCC
- Compliance Training and Education
- Delegation Oversight
- Delegation Reporting and Compliance Plan
- DHCS and DMHC All Plan Letters, Policy Letters, and Regulatory Requirements
- Disciplinary Guidelines
- DMHC Administrative Services Agreement Filings
- DMHC Annual Antifraud Report Requirements
- DMHC Filing Requirements
- DMHC Review of Records
- Effective Lines of Communication
- Enforcement Actions Administrative and Monetary Sanctions
- False Claims Act
- Key Personnel and Business Administration Change
- Provider False Claims Act
- Response to Detected Offenses and CAPS
- U.S. Patriot Act
- Written Policies and Procedures
- CalAIM Oversight of ECM Providers
- Delegation and Subcontractor Relationships
- Delegation Oversight and Vendor Management
- Dispute Resolution with County Mental Health Plan
- DMHC Block Transfer Policy
- DMHC Timely Access Reporting – Enrollee Experience Survey
- DMHC Timely Access to Care
- Letter of Agreement
- Medi-Cal Electronic Visits Verification (EVV) Requirements
- Mental Health Services under Managed Medi-Cal
- MOUs with Local Government Agencies, County Programs, and Third Parties
- Network Development and Management
- Notice to Contracted Providers Regarding Corrective Action Plan
- Provider Advice to Member
- Provider Communications
- Provider Contracting and Fee Schedule Disclosure
- Provider Data Accuracy
- Provider Experience Survey
- Provider Manual
- Provider Training and Education
- Responsibilities to Transitional Rent Community Support Providers
- Street Medicine
- Support to Providers for Competent Language Services
- Telehealth Services
- CalAIM Community Support Services Utilization and Outcomes Monitoring
- Communicable Disease Reporting
- Cultural and Linguistic Competency Training and Education
- Cultural and Linguistic Services Programs
- Determination of High Volume Specialists
- Diversity, Equity, and Inclusion (DEI) Training
- Enrollee and Family Engagement Strategy
- Facility Site Review and Medical Records Review
- HEDIS Inter-Rater Reliability
- Housing And Homelessness Incentive Program
- Managed Care Pulse Session Performance Evaluation
- Member Health Record
- Member Satisfaction Survey
- National Committee for Quality Assurance Accreditation
- Peer Review Policy Medical Record Review
- Quality Improvement and Health Equity Transformation Program
- Record Retention and Document Management
- TGI Cultural Competency Training Program
- Abortion Services
- Access to Self Referred Covered Services
- Adverse Benefit Determination Appeal Process
- CalAIM Community Supports Referral and Authorization
- Clinical Criteria and Guidelines
- Communication Protocols with Emergency Departments
- COVID Therapeutics
- Dental Services
- Doula Services
- Emergency and Follow-up Care for Rape and Sexual Assault
- Hospice Care Benefit
- Hospice Utilization Management
- Independent Medical Review (IMR)
- Inpatient Concurrent Review
- Intermediate Care Facilities for Developmentally Disabled
- Inter-rater Reliability
- Over Under Utilization
- Post Stabilization
- Provisions of Service for Pregnant Women
- Skilled Nursing Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care
- Subacute Care Facilities
- Substance Use Disorder Treatment Services
- Transition of Care
- Utilization Management of Transitional Rent Community Support
- Utilization Management of Vendor Delegation Oversight
- Vision Care Services
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Page Updated: March 23, 2026 @ 6:50pm