Community Health Group

San Diego Medi-Cal and Medicare (CommuniCare Advantage HMO D-SNP, Community y Más HMO C-SNP) plan. Provider Services Specialists help with claim status, billing questions and provider portal access; non-contracted providers may email for claim status. Not a member line.

Mail-only address for non-contracted Medi-Cal claims. CHG prefers EDI; the page lists payer IDs by clearinghouse (e.g., Office Ally 66170 fee-for-service / 66171 capitated professional, Waystar Z1700). First-time submitters must send W-9 and NPI to Provider Enrollment.

Mail-only address for non-contracted Medicare claims (CommuniCare Advantage / Community y Más). EDI preferred; see payer IDs on the source page.

Send W-9 and NPI before or with a first claim to avoid processing delays. This is provider record setup, not network contracting or credentialing review.

Out-of-network providers may mail reconsideration requests with the CHG Provider Dispute Resolution form and supporting documentation; non-contracted providers for Medicare members must include a waiver of liability. An online disputes tool is also offered. Provider Services can explain how to submit.

Non-contracted (out-of-network) providers fax the Referral and Service Request Form; contracted providers submit through the provider portal. Form shows reviewed date 11/30/2022. The phone shown on the form is for urgent service requests and is also the Medi-Cal member services number.

Non-contracted providers only: follow up on authorization request status by email. Contracted providers check status in the provider portal.