Information for Providers

The CCHP Provider Relations and Contracting Units compose a team of qualified professionals who meet the needs of our network providers. The Provider Relations and Contracting Units have over 150 years of combined clinical, credentialing, contracting, private practice and managed healthcare experience to support over 5000 Primary Care and Specialty providers in our two primary networks; the Community Provider Network and the Regional Medical Center Network. The Provider Relations and Contracting Units are committed to solving the concerns of our providers while delivering excellent customer service and training to our providers and their staff. CCHP cares for over 200,000 members in Contra Costa County.

Forms and Resources

Behavioral Health

• AMSC: AUDIT | AUDIT-C
• Behavioral Health Evaluation
• Behavioral Health Referral for Adult
• Behavioral Health Referral for Child
• Contact Information for Noncontracting Hospitals

Claims

• Appeal and Dispute Form
• Corrected Claim Submission Guideline
• Tracer Form
• Long Term Revenue Codes
• FAQs for Clearinghouse Transition to Availity 9/20/21
• Reminder Balance Billing Members Prohibited

DHCS Adverse Childhood Experiences (ACEs) Screening

• Training to Screen for ACEs ↗

Fraud, Waste and Abuse (FWA) Policy

• Examples of Fraud
• Preventing Fraud Waste and Abuse - Policy 705-C
• Reporting Suspected Fraud Waste and Abuse - Policy 705-C

General Information

• Care Coordinator Listing All Health Centers

Health Education / Case Management

• Diabetes Prevention Program:
  • Diabetes Prevention Program Flyer
  • Provider Referral Form
• Child Health & Disability Prevention Program (CHDP) Brochure ↗
• Disease Management Referral Form
• Growing Up Healthy ↗
• Health Education Resource Guide
• High Blood Pressure Physician Resources
• Immunization's for a Healthy Pregnancy:
  • Immunization's for a Healthy Pregnancy | Spanish
  • Protect Your Baby from Whooping Cough | Spanish
• LGBTQ Resources
• Minor Consent Form Transportation-NEMT
• Nutrition and Weight Management Class Referral Form
• Pediatric Obesity Guidelines
• Physician Certification Statement (PCS) for NEMT
• POLST Form ↗
• Public Health Nurse Referral Form

Initial Health Assessment (IHA)

• Initial Health Assessment Tip Sheet
• Blood Lead Screening of Young Children Requirements for Providers

Member Services

• Direct Member Reimbursement Form
• Member Consent for Provider to File an Appeal | Spanish | Chinese
• Member Grievance and Appeal Form | Spanish | Chinese
• Member Rights | Spanish

Pharmacy

• Formulary Addition Request Form
• Medication Prior Authorization Request (PA) form

Provider Relations

• Provider Complaint Form

Social Determinants of Health Resources

• Community Supports (CS) Criteria
• ECM Criteria

Utilization Management

• AMSC: AUDIT | AUDIT-C
• Contact Information for Noncontracting Hospitals
• Chronic Pain Management Policy
• Disclosure of UM Criteria or Guidelines Request Form
• Enhanced Care Management (ECM) Criteria
• Bariatric Surgery Mental Health Assessment
• Minor Consent Form Transportation-NEMT
• Neurosurgical Referral Guidelines
• Physician Certification Statement (PCS) for NEMT
• Prior Authorization Request/Referral (PA) Form
• Prior Authorization Request/Referral (PA) Form – Bariatric Bypass
• Synagis Prior Authorization Request form

Options

• Bulletins
• CalAIM Programs
• Case Management (CM) Programs
• ccLink Provider Portal
• Claims Information
• Clinical Guidelines
• Forms & Resources
• FSR Tool
• Health Education Resources
• Interactive No Authorization Required List
• Interpreter Services
• Join Our Network
• Medi-Cal Rx Transition
• Pharmacy & Therapeutics
• Preferred Drug List (PDL)
• Provider Manual
• Provider/Pharmacy Directory
• Quality
• Telehealth Information
• Trainings
• Utilization Management: Authorization and Referrals
• Contact Us