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Provider Resources

Attestation Form

Gold Coast Health Plan (GCHP) has created a convenient online provider attestation form that will allow for the timely acquisition and gathering of network reporting requirements required by the state Department of Health Care Services (DHCS).

Access provider attestation form.

Behavioral Health

Beacon Health Options partners with Gold Coast Health Plan (GCHP) to manage the mental health benefit of Medi-Cal beneficiaries. The Primary Care Provider (PCP) referral form allows PCPs access to the services available through Beacon.

Care Management

Care Management Referral form (English and Spanish).

Clinical Practice Guidelines

Gold Coast Health Plan's (GCHP) Medical Advisory Committee adopts clinical practice guidelines to educate providers regarding comprehensive, current, evidence-based management practices to improve quality of care. Clinical practice guidelines minimize inter-practitioner variation in an attempt to reduce the use of outdated approaches to care. These guidelines may also be used to define objective clinical criteria for measurement of provider performance, may assist in making utilization management determinations, and will define best practices for Care Management and Disease Management programs.

Community-Based Adult Services (CBAS) Program

The Community-Based Adult Services (CBAS) Program replaced the state's Adult Day Health Care program and is managed by Gold Coast Health Plan (GCHP). CBAS requires prior authorization.

Visit aging.ca.gov to learn more about CBAS.

CORE Channel

In compliance with CAQH CORE Operating Rules, Gold Coast Health Plan (GCHP) now offers providers the following options:

Note: The systems used for the CORE Channel transactions have a standard maintenance schedule of 10 p.m. to midnight PST Sunday. The systems are unavailable during this time.

Disease Management

Gold Coast Health Plan (GCHP) aims to improve the health of its members and their families by partnering with its network of providers to deliver evidence-based care.

The Disease Management Program is a free service for members that provides them with targeted interventions to help manage chronic conditions like asthma, diabetes and prediabetes. The goal of the program is to work with Primary Care Providers (PCP), specialists and members to identify the best ways for members to stay as healthy as possible, reduce or delay long-term complications, and manage the member's conditions with appropriate care for the best health outcomes. The program offers members:

  • Educational materials and links to resources in English or Spanish.
  • Classes taught in English or Spanish, when available, near the member’s home or work.
  • An individualized care plan and access to work with a nurse health coach.

For more information, here are some helpful links:

Grievance and Appeals

Gold Coast Health Plan (GCHP) offers a process for providers to have claim-related issues resolved and/or to express their dissatisfaction with an action that was taken. For complaints concerning refunds or corrected claims, please consult the GCHP Provider Manual.

To better serve its providers, GCHP has streamlined the submission process by offering one submission form that will allow you to indicate whether you are submitting one of the following:

  • Provider Dispute – A request for reconsideration of an original claim that has been previously denied or underpaid.
  • Appeal – A request for reconsideration of an authorization denial or a notice of action.
  • Grievance – A request for reconsideration of a previously disputed claim in which the provider is not satisfied with the resolution outcome.

Provider Claim Reconsideration Form

Click here to watch a provider training video on how to fill out this form properly.

Submit your completed forms to:

Gold Coast Health Plan
Attn: Provider Disputes & Grievances
P.O. Box 9176
Oxnard, CA 93031

Immunizations

Gold Coast Health Plan (GCHP) supports the efforts of its providers to protect patients of all ages against vaccine-preventable diseases.

The Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) have immunization resources available for healthcare professionals.

CDC Resources:

  • The #HowIRecommend vaccination videos explain how to make effective vaccine recommendations, address common questions and take a team-based approach to vaccinations.

CDPH Resources:

For additional resources or information, please email QualityImprovement@goldchp.org or HealthEducation@goldchp.org.

Long-Term Care

The LTC 25-1 Form is preferred. Generating this typed form will help us expedite payment of claims. Please include the diagnosis code for each member each week.

Mail the 25-1 Form to:
Gold Coast Health Plan
Attention: Claims
P.O. Box 9152
Oxnard, CA 93031-9152

Direct authorization questions to:
Health Services
1.888.301.1228

Managed Care Accountability Set (MCAS)

Managed Care Accountability Set Quality Measures

Effective in Reporting Year 2020, Gold Coast Health Plan (GCHP) will monitor and report on the Managed Care Accountability Set (MCAS) performance measures. MCAS is based on the Centers for Medicare and Medicaid Services Child and Adult Core Set Measures. All state Medi-Cal Managed Care Plans are required to annually monitor and report these measures to the state Department of Health Care Services.

MCAS Reference Materials

To help providers understand the MCAS performance measure requirements, GCHP’s Quality Improvement Department has developed a reference guide and tip sheets to share key information on individual MCAS measures. These tip sheets are not intended to direct clinical judgment, but to serve as resources in understanding measurement specifications while providing guidance for measure compliance.

MCAS Tip Sheets

MCPDIP Provider Form

The Managed Care Provider Data Improvement Project (MCPDIP) is a state-issued requirement change for the submission of provider data that replaces the current monthly submission procedure governed by APL-14006. MCPDIP will allow the state Department of Health Care Services (DHCS) to monitor Gold Coast Health Plan's (GCHP) provider network.

Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT)

Non-emergency medical transportation (NEMT) is a ride for medical care that is not an emergency. NEMT is provided for Gold Coast Health Plan (GCHP) members who cannot sit in a regular vehicle due to a medical condition and who need to be transported in a specialized vehicle, such as a gurney van. NEMT is covered by GCHP.

Providers must complete the NEMT Prescription / Attestation of Medical Necessity form and fax it to GCHP at 1.855.883.1552. Completion of the form by providers ensures that a physician has reviewed the requirements for NEMT under state regulation Title 22.

Access the NEMT Prescription / Attestation of Medical Necessity form.

Once GCHP notifies its contracted transportation provider, Ventura Transit System (VTS), that the member is eligible, VTS will contact the member to arrange transportation.

Non-medical transportation (NMT) is a ride to get to medical care when the member does not have any way to get to that care for services such as scheduled appointments at any medical clinic or provider, dentist, eye doctor or vision center, pharmacy, equipment provider, behavioral therapy visit or approved health education program.

GCHP members who require NMT services should contact the Plan's contracted provider, Ventura Transit System (VTS), directly at 1.855.628.7433/1.800.855.7100 (California Relay Service) to arrange for transportation. Prior to receiving services for the first time, members must attest to VTS that they have no other means of transportation. Members should contact VTS at least 48 hours in advance of the transportation need and be prepared to show their GCHP member ID card.

GCHP reviews and coordinates both NEMT and NMT eligibility with VTS.

Download a list of frequently asked questions (FAQs).

GCHP offers NEMT and NMT for eligible members who need a ride to their dialysis appointments. Download some helpful tips for members when scheduling dialysis transportation.

If you have any questions, email GCHP's Provider Relations Department at ProviderRelations@goldchp.org.

Provider Manual

The Provider Manual describes operational policies and procedures relative to the provision of healthcare services to Gold Coast Health Plan (GCHP) members. Revisions and updates are made frequently.

We welcome your comments for changes and additional topics to include in this manual. Please email your comments to the Provider Relations Department at ProviderRelations@goldchp.org or through our call center at 1.888.301.1228.

Request for Authorization

The Direct Referral Authorization Form is for use by Primary Care Providers when referring members to an in-network, in-area specialist.

The Home Health Prior Authorization Checklist is for use by providers to facilitate the prior authorization process for home health requests.

The MyGoldCare™ palliative care program is available for any member who qualifies. This does not result in a reduction in benefits for members. Providers must complete the MyGoldCare Palliative Care Preauthorization Request Form. This ensures that qualifying members receive care in appropriate settings based on their needs in a timely manner.

The Preauthorization Treatment Request Form is for use by providers when referring members for services found on the Authorizations Required List.

The Radiology Request Form is for use by providers when referring members for CT/MRI/MRA/PET and Clinical Pre-Authorization imaging services.

Services Requiring Prior Authorization provides the list of services requiring prior authorization by our Health Services Department.

The Transplant Preauthorization Request Form is used by providers and transplant centers when referring members for transplant services.

Submit Authorizations:

  • Fax: 1.855.883.1552
  • Mail:
    Gold Coast Health Plan
    Attention: Authorizations
    P.O. Box 9152
    Oxnard, CA 93031-9152

For more information concerning authorizations, Providers can call GCHP at 1.888.301.1228.

Tri-Counties Regional Center (TCRC)

Tri-Counties Regional Center (TCRC) provides individual and family centered supports for members with developmental disabilities to maximize opportunities and choices for living, working, learning and recreating in the community. To be eligible for services, a person must have a disability that begins before the person's 18th birthday, be expected to continue indefinitely and present a substantial disability as defined in Section 4512 of the California Welfare and Institutions Code. Eligibility is established through diagnosis and assessment performed by regional centers. If you have a patient you think is eligible for TCRC services, please contact TCRC at 1.805.485.3177 or 1.800.664.3177.

Access the Tri-Counties Regional Center website.

GCHP care managers strive to coordinate care with TCRC. If you identify a patient who should be receiving resources from TCRC and who also needs help with coordination of care for a medical problem, please complete a Care Management Provider Referral Form.

Care Management Provider Referral form (English and Spanish).