DialClerk Directory

Community Health Group

Prior authorization

Locate authorization teams and submission faxes. Medical, pharmacy and delegated reviews can follow different routes.

fax prior auth

Referral and service request form — non-contracted providers

Official page read
Phone800-224-7766

Urgent service requests per the form instructions.

Fax

800-870-8781

Completed referral and service request form with clinical documentation.

Published hours

Not published in this record

Product, plan and location

medicaid · dsnp · medicare advantage
California

Mailing address

Not researched for this route

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.

View source ↗ · Source checked 2026-10-24 · Current page: non-contracted providers submit the referral form via fax ↗

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Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

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Locate authorization teams and submission faxes. Medical, pharmacy and delegated reviews can follow different routes.

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  • Ordering and rendering provider details
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  • Existing authorization or submission reference

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  • Which documents are missing, and where should they be sent?
  • What is the case number and next status-check date?

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