Other Health Coverage (OHC) Referral Form
Please provide the following information and click Submit Form at the bottom of this page.
Fields marked with an asterisk (*) are required.
Contact Provider Services
General | 831-430-5504 |
Claims Billing questions, claims status, general claims information |
831-430-5503 |
Authorizations General authorization information or questions |
831-430-5506 |
Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
Pharmacy Authorizations, general pharmacy information or questions |
831-430-5507 |