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.

2020 Plan Publications

• 2020 Summary of Benefits
• 2020 Annual Notice of Changes (ANOC)
• 2020 Evidence of Coverage
• 2020 Comprehensive Formulary (effective January 1, 2020; last updated August 27, 2019)
• 2020 Prescription Drug Prior Authorization Criteria (effective January 1, 2020)
• 2020 Prescription Drug Step Therapy Criteria (effective January 1, 2020)

2019 Plan Publications

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

Provider Directories

• Search online using our Network Provider/Facility/Pharmacy Search application
• Provider and Part B Pharmacy Directory (last updated  November 1, 2019)
• Part D Pharmacy Directory (last updated November 1, 2019)

Provider Publications and Documents

• Improving HEDIS Scores
• Homeless Provider Communication
• NPI Tax ID Flyer
• Waiver of Liability Statement
• 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

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