Providers

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
  • View Claims
  • Search and Submit Requests for Authorizations
  • Message Customer Service

Wait Time Appointment Survey Now Underway

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. Click here to download your Preferred Drug List (PDL).

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:

  1. The request for coverage is for an indication supported by the medical literature.
  2. 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.
  3. 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.
  4. 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.

A physician must submit the request utilizing form 61-211.  Please click here for the form Prescription Drug Prior Authorization / Step Therapy Exception Request Form.

If you have any questions, please contact MedImpact at 855-873-8739 to speak with a representative.

Language Assistance and Accessibility

Community Care Health offers a no-cost telephonic interpreter service to health plan members, both directly and through your offices, to provide language assistance to members with limited English proficiency. To get an interpreter, or to ask about written information in a non-English language for a member, please contact the health plan’s Customer Services department by phone at 1-855-343-2247. Community Care Health members are all entitled to full and equal access to covered services, including members with disabilities, as required under the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. Customer Service representatives for Community Care Health are accessible by phone at 1-855-343-2247, and are available to assist the speech and hearing impaired. Further, the speech – and hearing – impaired may use the California Relay Service’s toll-free telephone number 1-800-735-2929 or 1-888-877-5378 (TTY).

Timely Access To Care

Health Plans in California must ensure that members have timely access to their physicians and other providers when seeking care. This means that there are limits on how long members have to wait to get an appointment and telephone advice. The wait times are shown in the chart below. Some exceptions to the wait times apply. Sometimes waiting longer for care is not a problem. You may give a member a longer wait time if you determine it would not be harmful to the member’s health. In this event, you must note in the member’s record that a longer wait time will not be harmful to their health. If Members have questions that you are not able to answer, please direct them to Community Care Health’s Member Services Department at (855) 343-2247.
Appointment Type Standard
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
Behavioral Health Emergent & Non-Emergent Appointment Access Standards
Appointment Type Standard
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:
  • One follow-up encounter with a mental health provider within 7 calendar days after discharge
  • Plus
  • One follow-up encounter with a mental health provider within 30 calendar days after discharge

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.

Request a Provider Handbook

As a resource for contracted physicians, Community Care Health provides additional information about how the plan is organized and managed. If you are an affiliated physician and would like a copy, please complete the form below. Please allow up to five (5) business days for processing.