Non-Contracted Provider Resources
PHC California requires a current W‑9 form to be on file in order to process claims. The W‑9 form is used to verify a provider’s mailing and remittance address.
Claims received from providers that do not have a W‑9 form on file will be administratively denied as non‑clean claims. Providers are required to respond promptly to PHC California’s request for a valid W‑9 form in order to receive payment.
Non‑contracted providers must submit a completed W‑9 form with their initial claim submission to ensure timely claims processing and payment.
Providers may submit their W‑9 form using one of the following methods:
PDM Department Email: [email protected]
Fax: 888‑971‑4418 (Please fax the W‑9 form only. Do not include paper claims.)
All payments, including checks, claims remittance advices (ERAs), and IRS Form 1099s, will be mailed to the address listed on the W‑9 form, as applicable.
Providers must submit an updated W‑9 when changes occur, including but not limited to:
- Mailing address
- Legal business name
- Ownership
- Tax Identification Number (TIN)
- IRS form publication updates
Providers under the Medi-Cal program must not submit claims to, demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from other persons on behalf of the beneficiary, for any service included in the Medi-Cal program’s scope of benefits in addition to a claim submitted to the Medi-Cal program for that service.
Pursuant to Assembly Bill (AB) 2843, effective July 1, 2025, all in-network and out-of-network Providers are to provide coverage for “emergency room medical care” and “follow-up health care treatment” for a Member who is treated following a rape or sexual assault, without imposing cost sharing for the first nine months after the Member initiates treatment.
Please note that “follow-up health care treatment” includes medical or surgical services for the diagnosis, prevention or treatment of medical conditions arising from an instance of rape or sexual assault.
Please refer to the Penal Code Sections 261, 261.6,263, 263.1 & 286, 287, 288.7 for definitions of “rape” and “sexual assault”.
If you have any questions, please contact Provider Relations:
- Phone: (888) 726-5411
- Email: [email protected]
- Hours: Monday – Friday, 8:30 a.m. – 5:30 p.m. (closed weekends and holidays)
If you are interested in contracting with the PHC California please visit the Join Our Network page to get started.