• Skip to primary navigation
  • Skip to main content
  • Skip to footer
CHOC Health Alliance

CHOC Health Alliance

  • Members
    • Member Services
    • Member Handbook
    • Benefit Summary
    • Find a Provider
    • Urgent Care Centers
    • Your Privacy Rights
    • CHA Hospitals
    • Member FAQ
  • Providers
    • Authorizations
    • Compliance & Training
    • Portal
    • ICD 10 Resources
    • Claims
    • Newsletters
    • HEDIS Tools
    • Provider Manual and Forms
    • Provider Tools and Resources
    • Quality Improvement Advisor
    • Provider Roster
  • Join Our Network
  • Contact Us
  • (800) 424-2462

Provider Manual and Forms

The provider manual is a CHOC Health Alliance (CHA) administrative guide containing information to assist health care professionals with general information, policies, and procedures to assist when providing healthcare to our members. The manual contains helpful information and much more. The CHOC Health Alliance (CHA) provider manual will soon undergo revisions. We hope the new edition will allow you to find the information you need quickly. For more updates check back for helpful tips on doing business with CHA.

Provider Manual 
The policies and procedures in the manual are set forth by CHOC Health Alliance at our sole discretion. When necessary, subsections may be updated with or without notice by CHA at any time. It is the provider’s responsibility to review the Provider Manual for updates to our billing guidelines and other policies and procedures.

View Provider Manual

Provider Forms

Below are the most frequently requested forms.

Utilization Management Forms

CHA Prior Authorization – CHA Direct Referral Form – (chochealthalliance.com)

NEMT Authorization Request Forms – NEMT Authorization Form (chochealthalliance.com)

WCM CCS Eligibility Request Form – WCM-CCS-Eligibility-Request-Form.pdf (chochealthalliance.com)

Claims Forms

CHA Provider Dispute Resolution (PDR) – 15-PROVIDER-DISPUTE-RESOLUTION-REQUEST-031014-LLG_MAILING-ADDRESS-UPDATED_100617.pdf (chochealthalliance.com)

CalOptima Forms

Health Education and Disease Management Department Referral Form – FINAL-Form_Health-Edu-Dis-Mgmt-Referrals.pdf (chochealthalliance.com)

Case Management Forms

CHA Case Management Referral From – Microsoft Word – 949a-4e9f-af63-187a.docx (chochealthalliance.com)

Quality Measure Forms

Staying Health Assessment Tools – Staying Healthy Assessment Forms – CHOC Health Alliance (sunset)

Population Health Forms

The Plan-Do-Study-Act (PDSA) – QI Project Attestation & PDSA Form

Footer

.

American physicians group badge
  • CHOC
  • CalOptima – A Public Healthcare Agency
  • SSA Social Services Agency
  • Member Services
  • Find A Doctor
  • Benefit Summary
  • For Providers
  • HEDIS
  • Join Our Network
  • Contact Us
  • Nondiscrimination Notice

© CHOC Health Alliance