California
Provider Roster Import Resources
- Carelon Standard Provider Data Exchange Layout Guide
- Guide to Submitting Provider Test Files to Carelon
- SPI Sample Template for LEA
- Template SPI Provider Layout Data Fields for LEA
Student/Member Batch Registration Resources
Contact Information:
Carelon Behavioral Health
Phone: 833-917-1010
Email: cybhitpa@carelon.com
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.
Behavioral Health Policy and Procedure Manual for Providers
Primary Care Provider (PCP) Referral Form
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
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
ABA/BHT Referral Form (Medi-Cal)
Appointment Access Standards - Availability and Accessibility of Clinical Services
Behavioral Health Policy and Procedure Manual for Providers
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
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.
Behavioral Health Policy and Procedure Manual for Providers
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
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/BHT Referral Form (Medi-Cal)
Behavioral Health Policy and Procedure Manual for Providers
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
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
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.
