Publications and Forms

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

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 March 2018)
Prescription Drug Prior Authorization or Step Therapy Exception Request Form
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/Facility/Pharmacy Search application.
Provider and Pharmacy Directory (effective June 1, 2021)

To report any errors in the PHC California Provider and Pharmacy, please send an email to [email protected], or send a message using our web form. 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 Form 1.0