Contract Applications
Non-contracted providers have the right to request a reconsideration of Community Health Group’s denial of payment. In order to request a reconsideration, a non-contract provider must submit a Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal, CMC Waiver of Liability Form. Non-contracted providers have 60 calendar days from the date of this remittance advice to request a reconsideration.
Please include documentation with your reconsideration, such as a copy of the original claim or remittance notification showing the denial, and all clinical records or other documentation that supports the provider’s argument for reimbursement.
Please submit your request for reconsideration to the address below:
Community Health Group
Provider Disputes Department
2420 Fenton Street, Suite 100
Chula Vista, CA 91914
Contract Applications
Community Health Group only honors Contract Applications from the following providers at this time. If you are one of these providers, please click on the applicable specialty below for the corresponding application:
Notice to Non-Contracted Providers
Formulary
Medi-Cal Formulary Changes 2019
Cal MediConnect Medicare Formulary Changes 05/01/2019
Cal MediConnect Medicare Formulary Changes 06/01/2019
Cal MediConnect Medicare Formulary Changes 07/01/2019
Cal MediConnect Medicare Formulary Changes 08/01/2019
Cal MediConnect Medicare Formulary Changes 09/01/2019
Cal MediConnect Medicare Formulary Changes 10/01/2019
Cal MediConnect Medicare Formulary Changes 11/01/2019
Cal MediConnect Medicare Formulary
Cal MediConnect Medicare PA Criteria
Quality Improvement Program
Hospital Safety
Grievance Forms
English Medi-Cal Grievance Form
Arabic Medi-Cal Grievance Form
Spanish Medi-Cal Grievance Form
Vietnamese Medi-Cal Grievance Form
Tagalog Medi-Cal Grievance Form
Managed Care Medical links
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Referral Request Resources
CCS Service Authorization Request(SAR) Form
Referral and Service Request Form
No Authorization Required List (Medi-Cal and Cal MediConnect)
Credentialing
Credentialing Policy - Right to Review