PHP, California

Rachel Sakai
AHF Provider

Publications and Forms

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

2019 Plan Publications:

• 2019 Summary of Benefits
• 2019 Annual Notice of Changes (ANOC)
• 2019 Evidence of Coverage
• 2019 Comprehensive Formulary (effective February 1, 2019; last updated January 25, 2019)
• 2019 Prescription Drug Prior Authorization Criteria (effective February 1, 2019)
• 2019 Prescription Drug Step Therapy Criteria (effective February 1, 2019)

Provider Directories:

• Search online using our Network Provider/Facility/Pharmacy Search application
• Provider and Part B Pharmacy Directory (last updated  September 28, 2018)
• Part D Pharmacy Directory (last updated September 28, 2018)

Provider Publications and Documents:

• Prescription Drug Authorization Request
• Direct Referral Authorization Form
• Authorization Request Form
• Claim Dispute Submission Form
• Provider Grievance Form
• Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
• California Pre-Service Injectable Drug Authorization Request
• 2018 Model of Care Summary
• 2014 Cultural & Linguistics Program
• PHP Provider Manual

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.