Information for providers regarding claims, referrals /authorizations, provider credentialing, and Electronic Data Interchange (EDI) can be found here. The Claims Information page includes guidance on Claims Submission Requirements, Claim Dispute Resolution, and Fee Schedules. This information is compliant with California AB-1455 regulations. The page on Referrals and Authorizations provides data sheets and an on-line look up of medical specialists in the CHCN Network. The Credentialing page outlines the CHCN process for credentialing medical providers. The EDI page contains detailed specifications on the electronic transmission of membership, claims or payment information.
Will you be ICD-10 CM ready by October 1, 2015? CHCN will not accept ICD-9 coded claims once ICD-10 goes live. Click here to read more about this change and how it will affect you.
**HIPAA regulations require that patient identifiable health information be protected. Click here for a list of what is considered Protected Health Information.**