Provider Disputes
In-Network and Out-of-Network providers have the right to dispute Community Health Group’s (CHG) payment or denial of a claim. This includes refund request letters from CHG to a provider.
In-Network Providers may utilize CHG’s Provider Disputes Online Tool to submit disputes. Our Provider Services Specialists are available at 619-240-8933 to assist with any questions on how to use the dispute tool. It’s important to consider the time frame for filing a dispute outlined in your contract.
Out-of-Network providers have 365 calendar days, calculated from the date of the Remittance Advice, within which they may request a dispute resolution using the CHG PDR form.
Please include documentation with your reconsideration, such as the remittance notification showing the denial, all clinical records, or other documentation that supports the provider’s argument for reimbursement.
Out-of-Network providers may submit a 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 is only accepting Contract Applications from the following provider types 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
Psychology (Ph.D, Psy.D, LMFT, LCSW)
Formulary
D-SNP Formulary and Prescription Information
Cal MediConnect Medicare Formulary Changes 05/01/2020
Cal Mediconnect Medicare Formulary Changes 06/01/2020
Cal MediConnect Medicare Formulary Changes 08/01/2020
Cal MediConnect Medicare Formulary Changes 09/01/2020
Cal MediConnect Medicare Formulary Changes 10/01/2020
Cal MediConnect Medicare Formulary Changes 12/01/2020
Cal MediConnect Medicare Formulary Changes 04/01/2021
Cal MediConnect Medicare Formulary Changes 06/01/2021
Cal MediConnect Medicare Formulary Changes 07/01/2021
Cal MediConnect Medicare Formulary Changes 09/01/2021
Cal MediConnect Medicare Formulary Changes 10/01/2021
Cal MediConnect Medicare Formulary Changes 11/01/2021
Cal MediConnect Medicare Formulary Changes 12/01/2021
Cal MediConnect Medicare Formulary Changes 01/01/2022
Cal MediConnect Formulary Changes 03/01/2022
Cal MediConnect Formulary Changes 04/01/2022
Cal MediConnect Formulary Changes 05/01/2022
Cal MediConnect Formulary Changes 06/01/2022
Cal MediConnect Formulary Changes 07/01/2022
Cal MediConnect Formulary Changes 09/01/2022
Cal MediConnect Medicare Formulary
Cal MediConnect Medicare PA Criteria
Quality Improvement and Health Equity Transformation Program
Quality Improvement and Health Equity Transformation Program Description
Hospital Safety
How to File a Grievance or Appeal
How to File a Grievance or Appeal
Grievance Forms
Grievance/Appeal Form - English
Grievance/Appeal Form - Arabic
Grievance/Appeal Form - Spanish
Grievance/Appeal Form - Vietnamese
Grievance/Appeal Form - Tagalog
Grievance/Appeal Form - Chinese
Managed Care Medical links
Medical links
Referral Request Resources
CCS Service Authorization Request(SAR) Form
Referral and Service Request Form
No Authorization Required List (Medi-Cal and Medicare)
PCS/NEMT Form: See below for submission
During normal business hours 8:00am - 5:00pm, please fax completed PCS/NEMT form to: 1-800-870-8781
During after-hours/weekend/holidays, please fax completed PCS/NEMT form to: 619-382-1210
For hospital discharge, please fill out PCS/NEMT form first before calling and fax to: 619-382-1210
Credentialing
Credentialing Policy - Right to Review
Credentialing Policy - Minimum Practitioner Standards
