California

CA Children & Youth Behavioral Health Initiative (CYBHI) Fee Schedule Program 

Carelon Behavioral Health of California website 

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.

 California Medi-Cal Provider Addendum

Level of Care Criteria 

Primary Care Provider (PCP) Referral Form 

 Transition of Care Tool

 

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 Care Management Referral Form 

 California Medi-Cal Provider Addendum

 Care Management Referral Form

 Primary Care Provider (PCP) Referral Form

 

Contact Information:

Carelon Behavioral Health
12900 Park Plaza Drive
Cerritos, CA 90703

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 

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.

 California Medi-Cal Provider Addendum

 Care Management Referral Form

 Primary Care Provider (PCP) Referral Form

 

Contact Information:

Carelon Behavioral Health
12900 Park Plaza Drive
Cerritos, CA 90703

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

 California Medi-Cal Provider Addendum

For Providers & Partners | Orange County California - Health Care Agency 

 

Contact Information:

Carelon Behavioral Health
2900 Park Plaza Drive
Cerritos, CA 90703

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.

 California Medi-Cal Provider Addendum

Level of Care Criteria 

 Primary Care Provider (PCP) Referral Form

 

Contact Information:

Carelon Behavioral Health
12900 Park Plaza Drive
Cerritos, CA 90703

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.

 California Medi-Cal Provider Addendum

 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
12900 Park Plaza Drive
Cerritos, CA 90703

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

 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

 

Maternal Mental Health

 

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