skip to content, health centers and clinics, search, accessibility statement

Contra Costa Health

Newsroom, About Us, Careers, Employees, Provider Information, Contact Us,

Provider Manual

CCHP Provider Manual

Appendices:

APPENDIX	TITLE
A	Abuse Reporting Forms: Child Abuse Instructions Child Abuse Report Domestic Violence Legal Requirements for Reporting Elder Abuse
B	Advanced Health Care Directive (English/Spanish)
C	Case Management Referral: Form Brochures - Provider Brochures - Member Minor Consent Form - Transportation-NMT
D	Claims: Corrected Claim Submission Guideline Appeal and Dispute Form Tracer Form
E	Confidential Morbidity Report
F	Contracted Hospitals – Hospitals Listing by City
G	Disease Management Referral Form
H	Fraud/Waste and Abuse Training for Providers
I	Pharmacy: Medication - Prior Authorization Request Request for Formulary Review
J	Member Services: Member Grievance and Appeal Form (English \| Spanish) Member ID cards \| Sample Member Rights (English \| Spanish) Member Consent for Provider to File an Appeal (English \| Spanish \| Chinese) List of Member Rights and Responsibilities (English \| Spanish)
K	Behavioral Health Evaluation Behavioral Health Referral for Child Behavioral Health Referral for Adult
L	CHDP Billing
M	Prior Authorization Request (PA) Form Prior Authorization Request/Referral (PA) Form – Bariatric Bypass Minor Consent Form Transportation-NEMT Disclosure of UM Criteria or Guidelines Request Form Physician Certification Statement (PCS) for NEMT
N	Provider and Member Call Centers
O	Provider Complaint Form
P	Seniors and Persons with Disabilities Cultural Sensitivity Training
Q	WIC Referrals: Pregnant Postpartum/Breastfeeding Woman Pediatric Referral
R	CPN PCP Orientation CPN Specialist Orientation CPN Urgent Care Orientation CPN Organizational Provider Orientation CCRMC Orientation CPN Community Health Worker (CHW) Orientation CPN Skilled Nursing Facilities Orientation

See more information designed specifically for health care providers.

[ help with PDF files ]