California

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

Primary Care Provider (PCP) Referral Form in Spanish 

Provider Frequently Asked Questions (FAQs) 

 

Contact Information:

Carelon Behavioral Health provides clinical staff coverage 24 hoursa day, 7 days a week, 365 days a year to respond to all member and provider calls.

Medi-Cal members: 855-765-9700
IHSS and MCAP members: 800-808-5796
TTY: 711

For all other questions or concerns, call Central California Alliance for Health's Member Services department at 800-700-3874 or TTY: 711. Member Services staff are available to take your call Monday to Friday, 8 a.m. to 6 p.m.

ABA Provider Manual 

Adult Behavioral Health Screening Form 

Behavioral Health Policy and Procedure Manual for Providers 

Child Behavioral Health Screening Form 

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

Primary Care Provider (PCP) Referral Form in Spanish 

 

Contact Information:

Medi-Cal members: 855-765-9700
IHSS and MCAP members: 800-808-5796
TTY: 711

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls.

For all other questions or concerns, call Central California Alliance for Health's Member Services department at 800-700-3874, TTY: 711. Member Services staff are available to take your call Monday to Friday, 8 a.m. to 6 p.m.

Behavioral Health Policy and Procedure Manual for Providers 

Behavioral Health Care Management Referral Form 

Care Management Referral Form 

Primary Care Provider (PCP) Referral Form 

 

Contact Information:

Carelon Behavioral Health
5665 Plaza Drive, Suite 400
Cypress, CA 90630

Phone: 855-765-9702
Fax: 562-402-2666
TTY: 800-735-2929

Business hours:
Monday to Friday, 8:30 a.m. to 5:00 p.m.

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent and routine calls.

Gold Coast Health Plan
711 East Daily Drive
Suite 106
Camarillo, CA 93010

Administration: 805-437-5500
Fax: 888-310-3660
Member Services: 888-301-1228
TDD/TTY: (888) 310-7347

http://www.goldcoasthealthplan.org 

ABA Provider Manual 

Appointment Access Standards - Availability and Accessibility of Clinical Services 

Behavioral Health Policy and Procedure Manual for Providers 

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

 

Contact Information:

Carelon Behavioral Health
5665 Plaza Drive, Suite 400
Cypress, CA 90630

Phone: 888-581-7526
Fax: 562-402-2666
TTY: 800-735-2929

Business hours:
Monday to Friday: 8:30 a.m. to 5:00 p.m.

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent and routine calls.

Health Plan of San Joaquin
7751 South Manthey Road
French Camp, CA 95231

Provider Services: 209-942-6340
Toll Free: 888-936-PLAN (7526) 
TTY: 711
Automated eligibility system: 209-942-6303
General fax: 209-942-6305
Authorization fax: 209-942-6302

www.hpsj.com 

For more information regarding California Health IPA (CHIPA), please contact us.

Contact Information:

Employee assistance program (EAP) – Please contact the Kaiser Permanente National EAP Provider Line 24 hours a day, 7 days a week by calling 888-677-9993.

Authorizations – Please visit ProviderConnect (preferred method) or contact us at 855-471-7005, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

ProviderConnect – Please contact our EDI Helpdesk at 888-247-9311, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

Contact Information:

Employee assistance program (EAP) – Please contact the Kaiser Permanente National EAP Provider Line 24 hours a day, 7 days a week by calling 888-677-9993.

Authorizations – Please visit ProviderConnect (preferred method) or contact us at 855-471-7005, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

ProviderConnect – Please contact our EDI Helpdesk at 888-247-9311, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

ABA Provider Manual 

Behavioral Health Policy and Procedure Manual for Providers 

Care Management Referral Form 

Primary Care Provider (PCP) Referral Form 

 

Contact Information:

Carelon Behavioral Health
5665 Plaza Drive, Suite 400
Cypress, CA 90630

Phone: 877-344-2858
Fax: 562-402-2666
TTY: 800-735-2929

Business hours:
Monday to Friday: 8:30 a.m. to 5:00 p.m.

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent and routine calls.

L.A. Care Contact Information
1055 W. 7th Street, 10th Floor
Los Angeles, CA 90017

Member Services: 888-839-9909
TTY: 711

Behavioral Health Policy and Procedure Manual for Providers 

 

Contact Information:

505 City Parkway West
Orange, CA 92868

Phone: 800-723-8641
Fax: 714-450-1593
TTY: 711

Business hours:
Monday to Friday, 7 a.m. to 6 p.m.

Members: 800-723-8641
TTY: 866-727-9441

Carelon Behavioral Health fax number: 714-450-1593

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent, and routine calls.

Behavioral Health Policy and Procedure Manual for Providers 

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

 

Contact Information:

Carelon Behavioral Health
5665 Plaza Drive, Suite 400
Cypress, CA 90630

Phone: 855-765-9703
Fax: 562-402-2666
TTY: 711

Business hours:
Monday to Friday, 8:30 a.m. to 5:00 p.m.
Phone: 562-467-5555

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent and routine calls.

Partnership HealthPlan of California
4655 Business Center Drive
Fairfield, CA 94534-1675

Phone: 800-863-4155

For more information regarding California Health IPA (CHIPA), please contact us.

ABA Provider Manual 

Behavioral Health Policy and Procedure Manual for Providers 

Care Management Referral Form 

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

Primary Care Provider (PCP) Referral Form in Spanish 

 

Contact Information:

Carelon Behavioral Health
5665 Plaza Drive, Suite 400
Cypress, CA 90630

Phone: 855-371-8117
Fax: 562-402-2666
TTY: 800-735-2929

Business hours:
Monday to Friday; 8:30 a.m. to 5:00 p.m.

Carelon Behavioral Health provides clinical staff coverage 24 hours a day, 7 days a week, 365 days a year to respond to all member and provider calls, including emergent, urgent and routine calls.

San Francisco Health Plan
P.O. Box 194247
San Francisco, CA 94119

Customer Service: 800-288-5555
TDD/TTY: 888-883-7347
http://www.sfhp.org

For more information regarding California Health IPA (CHIPA), please contact us.

ABA Authorization Request Form Medi-Cal 

ABA Provider Manual 

CHIPA 180 Waiver Request Form 

Provider Dispute Resolution (PDR) Form 

 

Community Health Worker Services Benefit Medi-Cal Only

 

For Medi-Cal providers interested in adding Community Health Worker Services to their Provider Service Agreement, please contact the Carelon National Provider Service Line at 800-397-1630, Monday through Friday, 8:30 a.m. to 5:00 p.m. EST or email the California Provider Relations team at provider.inquiry@carelon.com.

 

Please submit the individual Community Health Worker information on the Alternate Roster Template and submit a completed Community Health Worker Verification Form for each individual included on the roster.

 

Community Health Worker Services Benefit Provider Material – Medi-Cal Only 

ALTERNATE ROSTER TEMPLATE 

Community Health Worker Verification Form 500 Hours Core Competencies – Medi-Cal 

Community Health Worker Verification Form 10 Hours of Field Experience – Medi-Cal 

Community Health Worker Verification Form for Continuing Education Hours – Medi-Cal 

Today we are Carelon Behavioral Health, but when some of these materials were developed, we were Beacon Health Options.