Provider Services Archives

12212020_AccessTransgenderServices_Fax
Jim Lyons, Pending 2024 Review
Modified: 3/3/2021

12212020_Auth_Process_Update_Fax_Email
Jim Lyons, Pending 2024 Review
Modified: 3/3/2021

20201216_321570-H_Pfizer_StandingOrders-319pm
Jim Lyons, Pending 2024 Review
Modified: 4/15/2021

20201216_321629-E_VTF_ScreenChecklistContraPrec
Jim Lyons, Pending 2024 Review
Modified: 4/15/2021

2021-Provider-Satisfaction-Survey-Executive-Summary
Jim Lyons, Pending 2024 Review
Modified: 3/2/2022

2R_Minors-Rights-Statement
Jim Lyons, Pending 2024 Review
Modified: 5/14/2021

AdvanceDirective_Eng
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

AdvanceDirective_Span
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Allied_Credentialing_Application
Crystal Kerr, Pending 2024 Review
Modified: 6/29/2022

Auth and Requests in the Provider Portal Jiva Training
Heidi Seago, Maribel Quintero, Pending 2024 Review, Rachel Wy
Modified: 7/16/2024

AUTH_STATUS_REQUEST
Jim Lyons, Pending 2024 Review
Modified: 2/15/2022

Breastfeeding_Benefit_Description
Jim Lyons, Pending 2024 Review
Modified: 6/24/2021

CBAS_Inquiry_Form
Jim Lyons, Pending 2024 Review
Modified: 2/15/2022

Certification_Debarment
Jim Lyons, Pending 2024 Review
Modified: 2/15/2022

Certification_Regarding_Lobbying
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

CORP_Procedure-Code-Lookup-Tool-Job-Aid_D_EN
Jim Lyons, Pending 2024 Review
Modified: 10/5/2021

Corrected_Claim_Form
Pending 2024 Review, Sharlene Gianopoulos
Modified: 2/15/2022

Grievance_Tracking
Jim Lyons, Pending 2024 Review
Modified: 3/15/2022

ID_of_Overpayment_Form
Jim Lyons, Pending 2024 Review
Modified: 2/26/2022

Locum_Tenens_Notification
Jim Lyons, Pending 2024 Review
Modified: 2/15/2022

Long Term Support Services
Melissa Kelly-Ortega, Pending 2024 Review
Modified: 3/11/2024

Medical_Clearance_for_Dental_Anesthesia
Jim Lyons, Pending 2024 Review
Modified: 2/15/2022

MEM_2021-website-launch_F_ENG
Jim Lyons, Pending 2024 Review
Modified: 6/30/2021

MEM_2021-website-launch_F_HM
Jim Lyons, Pending 2024 Review
Modified: 6/30/2021

MEM_2021-website-launch_F_SP
Jim Lyons, Pending 2024 Review
Modified: 6/30/2021

MEM_Online-Provider-Directory-Tutorial_ENG
Jim Lyons, Pending 2024 Review
Modified: 6/18/2021

Member_Appt_No_Show_Notification
Jim Lyons, Pending 2024 Review
Modified: 2/16/2022

New_Non_PCP_Training
Jim Lyons, Pending 2024 Review
Modified: 2/21/2024

New_Provider_Training
Jim Lyons, Pending 2024 Review
Modified: 2/21/2024

PCL_combined
Jim Lyons, Pending 2024 Review
Modified: 2/1/2024

PCR_AUTH_REF
Jim Lyons, Pending 2024 Review
Modified: 2/25/2022

PCS_NEMT_Form
Jim Lyons, Pending 2024 Review
Modified: 2/16/2022

PD_IHSS
Melissa Kelly-Ortega, Pending 2024 Review, Rachaelle Schultze
Modified: 6/25/2024

PD_MC_Merced
Melissa Kelly-Ortega, Pending 2024 Review, Rachaelle Schultze
Modified: 8/26/2024

PD_MC_SB
Melissa Kelly-Ortega, Pending 2024 Review, Rachaelle Schultze
Modified: 8/26/2024

CCAH Monterey and Santa Cruz County Provider Directory

PD_MC_SC_MTRY
Melissa Kelly-Ortega, Pending 2024 Review, Rachaelle Schultze
Modified: 8/26/2024

POLST_2017_wCover
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Portal_Quick_Reference_Linked_Members
Pamila Vang, Pending 2024 Review
Modified: 7/1/2021

PROV_2021-website-launch_F_ENG
Jim Lyons, Pending 2024 Review
Modified: 6/30/2021

PROV_Change-in-Ownership_F_EN
Jessie Dybdahl, Pending 2024 Review
Modified: 4/28/2022

PROV_DME-Credentialing-Application_F_ENG
Crystal Kerr, Pending 2024 Review
Modified: 6/29/2022

PROV_doula-credentialing-application_fillable_final
Crystral Kerr, Jessie Dybdahl, Jim Lyons, Pending 2024 Review
Modified: 8/3/2023

PROV_ECM-CS-Invoice-FAQ
Jim Lyons, Pending 2024 Review
Modified: 7/12/2022

PROV_Maximizing-Routine-IZ-during-COVID_ENG
Jim Lyons, Pending 2024 Review
Modified: 6/4/2021

PROV_Member_Satisfaction_Toolkit_2021
Jim Lyons, Pending 2024 Review
Modified: 9/30/2021

PROV_Non-Physician-Medical-Practitioner_F_ENG
Jessie Dybdahl, Pending 2024 Review
Modified: 6/29/2022

PROV_Organizational-Provider-Credentialing-Application_F_ENG
Crystal Kerr, Pending 2024 Review
Modified: 6/29/2022

PROV_Outpatient-Laboratory-Provider-Credentialing-Application_F_ENG
Crystal Kerr, Pending 2024 Review
Modified: 6/29/2022

PROV_PassThrough-SupplementalPayments_FAQ_ENG
Jim Lyons, Pending 2024 Review
Modified: 8/22/2023

PROV_Physician-Credentialing-Application_F_ENG
Crystal Kerr, Pending 2024 Review
Modified: 4/21/2023

PROV_Transportation-Credentialing-Application_F_ENG
Crystal Kerr, Pending 2024 Review
Modified: 6/29/2022

Provider Portal Reports Webinar FAQ Guide
Pamila Vang, Pending 2024 Review, Ready for Remediation
Modified: 7/25/2024

Provider_Manual
Jim Lyons, Pending 2024 Review
Modified: 8/12/2024

Provider_Manual_072022
Jim Lyons, Pending 2024 Review
Modified: 6/9/2022

Provider-Portal-User-Guide
Pamila Vang, Pending 2024 Review
Modified: 8/20/2024

RA_Guide
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Request_Member_Reassignment_English

Request_Member_Reassignment_English
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Request_Member_Reassignment_Hmong

Request_Member_Reassignment_Hmong
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Request_Member_Reassignment_Spanish

Request_Member_Reassignment_Spanish
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

Spanish_POLST_2016
Jim Lyons, Pending 2024 Review
Modified: 5/28/2021

TeleMed2U_flyer_EN
Jim Lyons, Pending 2024 Review
Modified: 3/17/2023

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