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.

CHG Provider Dispute 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)

Pulmonology

Psychiatry

Colorectal Surgery

Hand Surgery

PCP

Oral Maxillofacial Surgery

Endocrinology

Infectious Disease 

Formulary

D-SNP Formulary and Prescription Information

Medi-Cal Formulary

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

Medication Request Form

Quality Improvement and Health Equity Transformation Program

Quality Improvement and Health Equity Transformation Program Description

Hospital Safety

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

Grievance/Appeal Form - Farsi 

Managed Care Medical links

AHIP

NCQA

Medical links

AMA

AHCPR

CMS

Center Watch

RxList

NLM

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  

Credentialing Application

Credentialing Addendum A

Credentialing Addendum B  

Summary of Delegation