To learn more, please review detailed info in "The Check-In" and know that Timely Access to Care Standards are always available on this website; please review with your staff.
Our provider partners can access vital information around the clock via the provider portal, which has been developed to present quick solutions available 24 hours a day / 7 days a week.
Once registered, the portal offers providers convenient access to the following functions:
-Verify Eligibility and Benefits
-Search and Submit Requests for Authorizations
-Message Customer Service
- Verify Eligibility and Benefits
- View Claims
- Search and Submit Requests for Authorizations
- Message Customer Service
Community Care Health is proud to partner with the Central Valley’s largest and most comprehensive physician panel. We’ll do our best to support you in delivering excellent care and an exceptional patient experience. Thank you for your commitment to quality, patient satisfaction and personalized care for our patients.
For more information about our member services please call Community Care Health customer service at 1-855-343-2247.
Pharmacy Coverage for CCH Members
CCH has partnered with MedImpact as our Pharmacy Benefit Manager to provide prescription drugs to our members. To find a participating pharmacy, please go to “Find a Provider” and click on the Pharmacy Tab.
CCH members are able to obtain a 90-day supply of ongoing medications through the mail-order program with MedImpact Direct. With mail-order, members can have their prescriptions delivered right to their home. To submit a prescription on behalf of a CCH member please click on the link to complete a MedImpact Direct Medication Order Form and submit electronically via ePrescribing or fax to 888-783-1773.
See what's covered for CCH members
Commonly Prescribed Medications
MedImpact has created a list of commonly prescribed medications within select classes of drugs covered by the member’s prescription drug plan. The PDL was created to promote clinically appropriate utilization of medications in a cost-effective manner.
Formulary Exception Request Process
MedImpact has established a process for providers to obtain non-preferred drugs (Formulary Exception) for members.
A physician may request a Formulary Exception if the following rules have been met:
- The request for coverage is for an indication supported by the medical literature.
- To be considered, a request for a Formulary Exception can be submitted after the member has undergone a therapeutic trial with at least two different formulary medication alternatives to the non-formulary medication being requested. In cases where only one formulary alternative exists, an adequate therapeutic trial with this one formulary alternative will be required before coverage of the non-formulary medication will be considered.
- Use of covered alternatives must be for a reasonable period of time, generally defined as one month of therapy or more, except in cases where the physician indicates clinical reason why alternatives are ineffective, intolerable, or unsafe.
- If the physician’s request for coverage of the non-formulary medication is only based upon the physician’s and/or member’s unwillingness to change to a formulary alternative, the request will not be considered.
If you have any questions, please contact MedImpact at 855-873-8739 to speak with a representative.
Language Assistance and Accessibility
Timely Access To Care
|Emergency Care (life threatening)||Seek immediate care at the nearest hospital|
|Urgent Care (non-life threatening) – no prior authorization required||Appointment is offered within 48 hours from time of the request|
|Urgent Care (non-life threatening) – prior authorization required||Appointment is offered within 96 hours from time of the request|
|Non-urgent appointments with a primary care physician (PCP) for regular and routine primary care services||Appointment is offered within 10 business days from time of the request|
|Non-urgent care appointments with a specialist||Appointment is offered within 15 business days from time of the request|
|Non-urgent appointment with a mental health provider (who is not a physician)||Appointment is offered within 10 business days from time of request|
|Non-urgent appointments for ancillary services for the diagnosis or treatment of an injury, illness or other heath condition||Appointment is offered within 15 business days from time of request|
|Telephone triage and advice*||No greater than 30 minutes|
|Non-urgent appointments with a physician mental health care provider||Must offer the appointment within 10 business days of request|
|Non-Urgent Care appointments with a non-physician mental health care provider||Must offer the appointment within 10 business days of request|
|Urgent Care appointments||Must offer the appointment within 48 hours of request|
|Access to Care for Non-Life Threatening Emergency||Within 6 hours|
|Access to Life-Threatening Emergency Care||Immediately|
|Access to Follow Up Care After Hospitalization for mental illness|| Must Provide Both:|
Other Regulatory Requirements:
After Hours Care: Members should be able to reach a recorded message or live voice response providing emergency instructions and for non-emergent (urgent) matters information when to expect to receive a call back.
Emergency Care: Providers should instruct their after-hours answering service staff that if the caller is experiencing an emergency, the caller should be instructed to dial 911 or to go directly to the nearest emergency room. Answering machine instructions must also direct the member to call 911 or go the nearest emergency room if the caller is experiencing an emergency.