Provider Manual


Brand New Day

Acupuncture and Chiropractic Benefits
2017 Benefit Matrix
Member Choice Flowchart
2017 Part D Standard Benefit for Medicare Members
Provider Rights and Responsibilities
2017 Provider Notification and APE Packet
Brand New Day APE Program

CalOptima Access Standards

2015 CalOptima Standards of Access to Care
2015 OneCare Standards of Access to Care
DMHC Access Standards (easy reference)

CalOptima Aid Codes

2015 Aid Codes Listing

CalOptima Programs

OneCare Connect
Behavioral Health
Enrollee Services
Grievance Appeals
Interdiciplinary Care Team
Long-Term Services and In-Home Supportive Services
Member Rights
Model of Care
Program Overview

Model of Care

Central Health Plan

Diabetic Supply Process
Diabetic Supply Final Provider Notice

CHDP Providers

Confidential Screening/Billing PM160 Claim Form Instructions
Pediatric Preventive Services FAQ
PM160 Form - Full Assessment
PM160 Form - Immunization Only
PM160 Form - Partial Assessment


Claim Instructions
OA Companion Guide
OA Service Center User Manual
PDR Submission Form

Compliance Training Attestations

UCMG 2017 FDR Compliance Attestation
UCMG 2017 Provider Training Attestation

Cultural and Linguistic

2015 Cultural and Linguistic Provider Education

Encounter Policy and Requirements

Medi-Cal Encounter Requirements

Initial Health Assessment Guide and Coding

IHA Reference Guide

Language Assistance Forms


Medi-Cal Guidelines

2018 Medi-Cal Program Updates and Resource

Member Rights and Responsibilities

2016 Member Rights and Resposibilities

P4P Program

2018 HEDIS Training Power Point
2018 HEDIS Quick Reference Guide
HEDIS Cheat Sheet 2018
Example of Provider Communication
Example of Member Communication

Prefered Laboratory Services Locations

Orange County PSC Maps

Provider Online Portal, Referral Instruction and Authorization Request Forms

Access Express Request Form
Access Express Step-By-Step
CalOptima Health Education and Disease Management Referral Form
CalOptima Mental Health Service - Behavioral Health Information
CalOptima HN New HMBO FAQs
CalOptima MH Services Breakdown 
Online Referral Submission
UCMG Direct Referral Form
UCMG Referral Form

Provider Preventable Conditions (CalOptima, Medi-Cal)

CalOptima FAQ Handout
DHCS All Plan Letter
DHCS Reporting Form

Provider Tools

Provider Sign-Off Sheet for Provider Manual
Optum Insider: Correctly Reporting Cancer Diagnoses
Optum Insider: Hermatologic Disorders
Optum Insider: Eye Diseases
Optum Insider: Vision Impairment
Optum Insider: Cardiovascular Disease
Optum Insider: Kidney Disease Reporting
Optum Insider: Hypertension and Stroke
Optum Insider: Major Depressive Disorder
Optum Insider: Mens Health
Optum Insider: Obesity
Optum Insider: Osteoporosis and Hyperparathyroidism
Optum Insider: Parkinsons Disease

Radiology Services

Radiology Services to Providers


Vital Signs
Audit - Spanish
Audit Screening Tool
Audit-C - Spanish
SBIRT Introduction
SBIRT Fact Sheet
Tool - Audit-C

Staying Healthy Assessment

Universal Provider Training
Instruction Sheet for Providers

Assessment Forms
0-6 Months
7-12 Months
1-2 Years
3-4 Years
5-8 Years
9-11 Years
12-17 Years

Tobacco Cessation Notification

Tobacco Cessation Notification

Updated Contact List

Updated Contact List

Urgent Care Listing

2017 Urgent Care Listing


Welcome to UCMG