Providers
CCH Customer Service is available Monday through Friday, 8am-5pm at 1-855-343-2247 to verify eligibility, benefits, check status of prior authorization and to review claims. Participating providers can also access vital information 24 hours a day / 7 days a week by logging into the Provider Portal. Once registered, the portal offers providers convenient access to verify eligibility, review benefits and view claims.
If you have a question regarding your provider contract or are not yet a participating provider but are interested in becoming one, please email, providerrelations@communitycarehealth.org and a representative will contact you within two business days.
If you are a non-contracted provider of behavioral health crisis services and are requesting authorization for the transfer of a stabilized CCH member’s care to another provider or authorization to provide post-stabilization care, please call Simple Behavioral (formerly known as Halcyon Behavioral) at (888) 425-4800.
Community Care Health is proud to partner with the Central Valley’s largest and most comprehensive physician panel. We’ll do our best to support you in delivering excellent care and an exceptional patient experience. Thank you for your commitment to quality, patient satisfaction and personalized care for our patients.
Pharmacy Coverage for CCH Members
CCH has partnered with MedImpact as our Pharmacy Benefit Manager to provide prescription drugs to our members. To find a participating pharmacy, please go to “Find a Provider” and click on the Pharmacy Tab. CCH has partnered with MedImpact as our Pharmacy Benefit Manager to provide prescription drugs to our members. To find a participating pharmacy, please go to “Find a Provider” and click on the Pharmacy Tab.
CCH members are able to obtain a 90-day supply of ongoing medications through the mail-order program with MedImpact. With mail-order, members can have their prescriptions delivered right to their home.
To submit a prescription on behalf of a CCH member please click on the link to complete a Birdi Enrollment/Medication Order Form and submit electronically via ePrescribing or fax to 855-873-8739.
See What's Covered for CCH Members
Commonly Prescribed Medications
MedImpact has created a list of commonly prescribed medications within select classes of drugs covered by the member’s prescription drug plan. The PDL was created to promote clinically appropriate utilization of medications in a cost-effective manner.
Formulary Exception Request Process
MedImpact has established a process for providers to obtain non-preferred drugs (Formulary Exception) for members.
A physician may request a Formulary Exception if the following rules have been met:
- The request for coverage is for an indication supported by the medical literature.
- To be considered, a request for a Formulary Exception can be submitted after the member has undergone a therapeutic trial with at least two different formulary medication alternatives to the non-formulary medication being requested. In cases where only one formulary alternative exists, an adequate therapeutic trial with this one formulary alternative will be required before coverage of the non-formulary medication will be considered.
- Use of covered alternatives must be for a reasonable period of time, generally defined as one month of therapy or more, except in cases where the physician indicates clinical reason why alternatives are ineffective, intolerable, or unsafe.
- If the physician’s request for coverage of the non-formulary medication is only based upon the physician’s and/or member’s unwillingness to change to a formulary alternative, the request will not be considered.
A physician must submit the request utilizing form 61-211. Please click here for the form Prescription Drug Prior Authorization / Step Therapy Exception Request Form.
If you have any questions, please contact MedImpact at 844-348-8510 to speak with a representative.
Language Assistance and Accessibility
Timely Access To Care
Medical and Mental Health Appointments and Timely Access to Care Health Plans in California must ensure that members have timely access to their physicians and other providers when seeking care. This means that there are limits on how long members have to wait to get an appointment and telephone triage or screening. The wait times are shown in the chart below. Some exceptions to the wait times apply. If you or a CCH member are having difficulty in obtaining a timely referral to an appropriate provider, please call CCH Customer Service at 1 (855) 343-2247. Providers and members can also file a complaint with the Department of Managed Health Care at www.HealthHelp.ca.gov or by calling 1 (888) 466-2219.
| Access Type | Standard |
|---|---|
| Access to non-urgent appointments with a Primary Care Physician (PCP) for regular and routine primary care services | Appointment is offered within 10 business days from time of the request |
| Access to Urgent Care services with a PCP that does not require prior authorization – includes appointment with a physician, nurse practitioner or physician’s assistant in officer | Appointment is offered within 48 hours from time of the request |
| Access to after-hours care with a PCP | Ability for Member to contact an on-call physician after hours; return call within 30 minutes PCP provides appropriate after-hours emergency instructions |
| Access to non-Urgent Care appointments with a Specialist | Appointment is offered within 15 business days from time of the request |
| Access to Urgent Care services that require prior authorization with a Specialist or other provider | Appointment is offered within 96 hours from time of the request |
| Telephone triage and screening | Provided within 30 minutes |
| Non-urgent appointments for ancillary services for the diagnosis or treatment of an injury, illness or other health condition | Appointment is offered within 15 business days from time of request |
| Non-urgent appointments with a mental health or substance use disorder provider (who is not a physician) | Appointment is offered within 10 business days from time of request |
| Non-urgent follow-up appointments with a non-physician mental health or substance use disorder provider for members undergoing a course of treatment for an ongoing mental health or substance use disorder condition | Appointment is offered within 10 business days of the prior appointment |
Other Regulatory Requirements:
After Hours Care: Members should be able to reach a recorded message or live voice response providing emergency instructions and for non-emergent (urgent) matters information when to expect to receive a call back.
Emergency Care: Providers should instruct their after-hours answering service staff that if the caller is experiencing an emergency, the caller should be instructed to dial 911 or to go directly to the nearest emergency room. Answering machine instructions must also direct the member to call 911 or go the nearest emergency room if the caller is experiencing an emergency.
NOTICE TO PROVIDERS REGARDING COMMUNITY CARE HEALTH’S OBLIGATIONS UNDER AB 1184 EFFECTIVE 7/1/2022
We are providing you with the below information to educate you on our obligations as a health plan regarding confidential communications to members. We expect our contracted providers to comply with any federal or state requirements that directly apply to health care practices regarding these matters.
Members Have the Right to Receive Communications from Community Care Health in a Confidential Manner
California law requires that we communicate with members in a confidential manner if they request it. This means that we will direct any communications about their health care to the address, phone number, or email they provide to us, and not the address, phone number, or email we have on file for their household.
This includes statements regarding services they received, letters approving a service that requires prior authorization, or phone calls from our case management nurses — and more. Members do not need to tell us why they are requesting confidential communications, and we will never ask.
If members would like to receive communications from us at a different address, phone number, or email than the one we have on file for their household, or if they have any questions, they can call Customer Service during normal business hours at 1-855-343-2247.