California PHC

If you need a publication or form that is not available here, please contact Provider Relations.

• PHC California – Surgical Code Job Aid
• PHC California MediCal Required Local to National Billing Code Crosswalk
• Corrected Claim Guidelines
• Claims Status Template (to be used when emailing multiple claims status inquiries)
• Paper Claim – Return Mail Notice
• Delegated Roster Template
• AHF 2019 Cultural Competence Program
• Homeless Provider Communication
• NPI Tax ID Flyer
• Comprehensive Formulary (effective January 1, 2020)
• Prescription Drug Authorization Request
• Direct Referral Form
• 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
• PHC California Provider Manual (effective September 1, 2023)
• Quick Reference Guide

• To find a network provider, search online using our Network Provider and Facility Search application.
• Provider Directory (effective June 1, 2024)

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