Provider Services
Chief Medical Officer/Medical Director
CHG's Chief Medical Officer/ Medical Director is Dr. Alan J. Conrad, MD, MMM, CPE, FACHE, FAAPL
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 dispute resolution using the CHG PDR form. For CommuniCare Advantage and Community y Más members, non-contracted providers must submit a completed waiver of liability form to CHG with the completed PDR 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)
Formularies
D-SNP Formulary and Prescription Information
- Formulary Changes 02/01/2023
- Formulary Changes 03/01/2023
- Formulary Changes 04/01/2023
- Formulary Changes 05/01/2023
- Formulary Changes 06/01/2023
Cal MediConnect Medicare Formulary
- 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 07/01/2022
- Cal MediConnect Formulary Changes 09/01/2022
Cal MediConnect Medicare PA Criteria
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
Managed Care Medical links
Medical links
Referral Request Resources
CCS Service Authorization Request(SAR) Form
Referral and Service Request Form
Non-Specialty Mental Health (NSMHS) Treatment Authorization Form
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 (Tab 2)
4- If you have a question about services that do require an authorization, please click on the following link: Services That Require Prior Authorization (Tab 3)
5- For any other questions or requests, please chose from the list below:
- Request to update rendering/refer to provider
- Add or change CPT codes in existing authorization
- Request to Change the Facility
- Add/Change Diagnosis Code
- Other Requests
Credentialing
Credentialing Policy - Right to Review