Medical Information Release Consent Form In Contra Costa
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
1-877-661-6230 Call if you have a medical problem or if you have a medical question.
Submitting Claims The claim submission timeframe for Contra Costa Health Plan is 180 days from the date of service, or primary explanation of benefits (EOB), for both contracted and non-contracted providers. Claims received after 180 days will be denied for untimely filing.
Submitting Claims The claim submission timeframe for Contra Costa Health Plan is 180 days from the date of service, or primary explanation of benefits (EOB), for both contracted and non-contracted providers. Claims received after 180 days will be denied for untimely filing.
Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24-Hour Nurse Advice Line at 1-877-661-6230 (Option 1).
Call 800-495-8885 800-495-8885 is the central number for making appointments at our county health centers. For same-day or next-day appointments, it's best to call as early as possible.
CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.
Call 800-495-8885 800-495-8885 is the central number for making appointments at our county health centers. For same-day or next-day appointments, it's best to call as early as possible.
Contra Costa Health Plan (CCHP) follows all applicable Federal and State laws in the use of Telemedicine services to provide consultation, access and quality of care to our Medi-Cal and Commercial members.
CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.
Call the 24/7 ACCESS Line at 1-888-678-7277. Anyone can call for themselves or someone they care about.
