Utilization Management: Authorization and Referrals
The Authorization and Referral department receives prior authorization requests from RMC and CPN providers for medical office visits/procedures requested for their patients. The department is made up of Health Plan Authorization Representatives (HPAR's), Registered Nurses (RN's) and Board Certified Physicians (M.D.'s) that all work together.
The Contra Costa Health Plan's Authorization and Referral department is open Monday through Friday, from 8:00 AM to 5:00 PM. Providers can reach the Authorization/Referral department by calling the Provider Call Center at 1-877-800-7423 and choosing option 3. For non-urgent matters, the caller can leave a message at the above number. Messages are addressed the next business day. For urgent matters, the caller can stay on the line and be automatically transferred to the Advice Nurse Unit, which operates 24/7.
For a list of CCHP's prior authorization requirements, see the CPT search tool.
In accordance with CMS Final Rule CMS‑4201‑F, Contra Costa Health Plan publishes the following information:
- Internal coverage and medical necessity criteria
- List of services requiring prior authorization and related metrics
Click on the button below to access this information (registration required).
Resources for Members
- Authorization Rules for members
- Continuity of Care-Terminated Provider and New Members
- Member Request for Criteria & Guidelines | Spanish | Chinese
Gastric Surgery Guidelines
- Clinical Guidelines
- Referral Form - submit in ccLink or ccLink Provider Portal (paper copy for reference only)
- Bariatric Surgery Mental Health Assessment