Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
- PHC-CA MediCal Required Local to National Billing Code Crosswalk
- Corrected Claim Guidelines
- Paper Claim – Return Mail Notice
- Delegated Roster Template
- AHF 2019 Cultural Competence Program
- Homeless Provider Communication
- NPI Tax ID Flyer
- eHealth Suite Provider Portal Training
- Comprehensive Formulary (effective January 1, 2020)
- Prescription Drug Authorization Request
- Direct Referral Form
- 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
- Quick Reference Guide
- To find a network provider, search online using our Network Provider and Facility Search application.
- Provider Directory (effective May 1, 2023)
| To report any errors in the PHC California Provider Directory, 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 8:30 am and 5:30 pm, Monday through Friday. |
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.
DHCS 030716 PHC FR Form 1.0
