CCHP is a health maintenance organization (or HMO) delivering full-suite of quality health plan coverage to over 23,000 Members. Our service area includes San Francisco and San Mateo counties. We are committed to serving our community and are devoted to delivering the highest quality health plan to the people and organizations we serve. We consider our health care providers as our customers and vital partners in serving our Members.
More about CCHP
CCHP is a California licensed Knox-Keene health plan and offers a variety of commercial products for small and large group employers as well as products for individuals. In addition, CCHP is contracted with the Centers for Medicare and Medicaid Services (CMS) to offer a Medicare Advantage HMO plan (Part C), a Medicare Advantage Special Needs Program (HMO SNP), and an integrated Medicare Advantage Prescription Drug Plan (Part D). CCHP’s Senior Program (HMO) is for people with Medicare Parts A and B. CCHP’s Senior Select Program (HMO SNP, Special Needs Plan) is for people with Medi-Cal and Medicare Parts A and B.
CCHP will resolve each provider dispute within 45 business days following receipt of the dispute, and will provide the provider with a written determination stating the reasons for the determination.
Non-Contracted Provider Dispute Resolution Process For CMS Medicare Advantage Plan Members
A non-contract provider, on his or her own behalf, is permitted to file a standard appeal for a denied claim only if the non-contract provider completes a waiver of liability statement, which provides that the non-contract provider will not bill the Medicare member regardless of the outcome of the appeal. The health plan cannot undertake a review until or unless such form/documentation is obtained.
Download details of the CMS Non-Contracted Provider Dispute Process (PDF).
Download the Waiver of Liability Statement (PDF).
CCHP Provider Manual
You can download your very own copy of CCHP Provider Manual:
The Centers for Medicare and Medicaid Services (CMS) requires annual fraud, waste and abuse training for organizations providing health, prescription drug, or administrative services to Medicare Advantage (MA) or Prescription Drug Plan (PDP) enrollees on behalf of a health plan. Providers must be knowledgeable with the federal requirements and information regarding fraud, waste and abuse. Please take a moment to go over the provided information in the PDF file link below.
Report Provider Directory Changes and Inaccuracies
Please call, email or submit form if you find any inaccuracies with the provider information on our website. You can also use this page to report any changes in the provider’s information such as phone number, language, and location.
To check a CCHP plan drug list, a comprehensive formulary and pharmacy can be found below. If you have any questions, please contact Member Services.
Effective July 1, 2014, the new Prescription Drug Prior Authorization Request Form is required for non-Medicare plans. View (Section 1300.67.241) (PDF) to read the complete DMHC regulations specifying the process.