Contract Applications 

Non-contracted providers have the right to request a reconsideration of Community Health Group’s denial of payment. In order to request a reconsideration, a non-contract provider must submit a Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal, CMC Waiver of Liability Form.  Non-contracted providers have 60 calendar days from the date of this remittance advice to request a reconsideration.

Please include documentation with your reconsideration, such as a copy of the original claim or remittance notification showing the denial, and all clinical records or other documentation that supports the provider’s argument for reimbursement.

Please submit your 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 only honors Contract Applications from the following providers 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

Behavioral Health Therapy

Colon and Rectal Surgery

Endocrinology

Hand Surgery

Infectious Disease

Oral Maxillofacial Surgery

Orthopedic Surgery

Psychiatry

Primary Care (FP, IM, GP)

Pulmonology (office based)

Rheumatology

Formulary

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

Cal MediConnect Medicare PA Criteria

Medication Request Form

Quality Improvement Program

Quality Improvement Program

Hospital Safety

Hospital Safety

Grievance Forms

English Medi-Cal Grievance Form

Arabic Medi-Cal Grievance Form

Spanish Medi-Cal Grievance Form

Vietnamese Medi-Cal Grievance Form

Tagalog Medi-Cal Grievance Form

Managed Care Medical links

AHIP

NCQA

Medical links

Medical Matrix

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 Cal MediConnect)

Credentialing

Credentialing Policy - Right to Review

Credentialing Policy - Minimum Practitioner Standards

Credentialing Application

Credentialing Addendum A

Credentialing Addendum B