Frequently Asked Questions

For Providers

If you are interested in becoming a CCH participating provider, please send an email to providerrelations@communitycarehealth.org and a representative will contact you within two (2) business days.
CCH offers both health maintenance organization (HMO) and exclusive provider organization (EPO) plans to large and small group employers.
A health maintenance organization (HMO) is a benefit plan that provides covered services through a defined network of physicians, hospitals and other providers. Members must select a primary care physician (PCP) who is responsible for managing their care and referring them to specialists when necessary. Except for urgent care, emergencies and services authorized in advance by CCH, services rendered by non-participating providers are not covered.

An exclusive provider organization (EPO) is a benefit plan that provides covered services through a defined network of physicians, hospitals and other providers. Members in an EPO are not required to select a primary care physician (PCP) or obtain a referral for routine specialty care. However, prior authorization may be necessary for specialized care such as outpatient services, inpatient services, certain diagnostic tests, etc. Like an HMO, services rendered by non-participating providers are not covered, except for urgent care, emergencies and services authorized in advance by CCH.

EPO benefit plans are different from HMO benefit plans in two important ways:

  • No PCP selection/assignment is required for EPO, and
  • EPO members can self-refer for specialty care (no PCP referral is required).

Prior authorization is the process of evaluating medical services in advance in order to determine medical necessity, appropriateness, and benefit coverage. Services requiring prior authorization should not be scheduled until you receive approval from CCH. CCH reserves the right to deny payment for authorized services if inaccurate information was provided to support the authorization request.

Please see list of codes requiring prior authorization.

Complete the Request for Prior Authorization form and fax it to (559) 243-7102.

CCH is Fresno’s only locally-based, commercial health plan.  We serve members in Fresno, Kings, and Madera counties. 

Members should present their CCH ID card when they seek services.  The ID card will display whether the member is enrolled in an EPO or HMO benefit plan. For a sample EPO or HMO ID card, please click on the applicable card below.

[Sample HMO Card]   [Sample EPO Card]

Please contact Customer Service at (855) 343-2247, Monday-Friday from 8am-5pm to verify eligibility, benefits, and copayment information.

CCH Providers should send claims to the following addresses:

Medical Claims:
Community Care Health
P.O. Box 45026 Fresno, CA 93718

Electronically using Payor ID 85729

Behavioral Health Claims:
SimpleBehavioral
PO Box 25159
Fresno, CA 93729-5159

Electronically through: OfficeAlly – Payor ID: HALCY
Fax: (855) 486-1341

Physical Medicine Claims:
SimpleMSK
PO Box 25220
Fresno, CA 93729-5220

Electronically through:
OfficeAlly – Payor ID: PM001
Fax: (855) 486-1343

HMO members will have the opportunity to choose a PCP when they enroll. If a member does not choose a PCP at the time of enrollment, CCH will assign one. If at any time the member wants to change their PCP, they can call Customer Service for assistance at (855) 343-2247.

CCH is a comprehensive health care service plan that covers a full range of medical care. Covered services include, but are not limited to, doctor office visits, hospital stays, surgeries, outpatient procedures, preventive services (periodic immunizations, physical exams, and routine screenings), prescription drugs, mental health and substance use disorder treatment, and much more, subject to proper authorization. Members can find additional information on benefit coverage in their evidence of coverage (EOC).