Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
2020 Plan Publications
- 2020 Summary of Benefits
- 2020 Annual Notice of Changes (ANOC)
- 2020 Evidence of Coverage
- 2020 Comprehensive Formulary (effective July 1, 2020; last updated June 25, 2020)
- 2020 Prescription Drug Prior Authorization Criteria (effective July 1, 2020)
- 2020 Prescription Drug Step Therapy Criteria (effective July 1, 2020)
Provider Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory (last updated June 24, 2020)
- Part D Pharmacy Directory (last updated June 24, 2020)
| To report any errors in the PHP provider or pharmacy, please send an email to california.directory.errors@positivehealthcare.org, or send a message using our web form. You may also report directory errors by calling Provider Relations at (888) 726-5411 between the hours of 8:00 am to 8:00 pm, Monday through Friday. |
Provider Publications and Documents
- Quick Reference Guide
- Improving HEDIS Scores
- Homeless Provider Communication
- NPI Tax ID Flyer
- Waiver of Liability Statement
- Prescription Drug Authorization Request
- Direct Referral Authorization Form
- Authorization Request Form
- Claims Dispute Submission Form
- Provider Grievance Form
- Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
- California Pre-Service Injectable Drug Authorization Request
- 2018 Model of Care Summary
- 2014 Cultural & Linguistics Program
- PHP Provider Manual
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.