Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
- Member Language Assistance Services for Providers
- PHC California – Surgical Code Job Aid
- Medi-Cal Anesthesia Billing 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 October 1, 2024)
- Quick Reference Guide
- To find a network provider, search online using our Network Provider and Facility Search application.
- Provider Directory (effective September 1, 2024)
| 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
Page Updated: October 2, 2024 @ 5:36pm