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)

Oral Maxillofacial Surgery

Endocrinology

Infectious Disease

Formularies

Medi-Cal Formulary

D-SNP Formulary and Prescription Information

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

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

Referral Request Resources

CCS Service Authorization Request(SAR) Form

Referral and Service Request Form

ABA Referral Form

Services Requiring Authorization/Services Not Requiring Authorization 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

Provider Email Forms

Please note this is not for submitting a new authorization.

1- If your request is for authorization status, please check the notification center

2- If you’re having issues with your provider portal access, please contact the provider relations specialists at (619) 240-8933 for further assistance

3- If you have a question about services that do NOT require an authorization, please click on the following link: Services That Do Not Require Prior Authorization (Medi-Cal & Medicare) (page 1-4)

4- If you have a question about services that do require an authorization, please click on the following link: Services Requiring an Authorization (page 4 to end)

5- For any other questions or requests, please chose from the list below:

Credentialing

Credentialing Policy - Right to Review

Credentialing Policy - Minimum Practitioner Standards

Credentialing Application

Credentialing Addendum A

Credentialing Addendum B