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.
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) – PDSA Worksheet
