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Balance Provider Portal

Check a patient’s eligibility, claims status, view patient’s health plan benefits and summaries, patient’s deductible/out of pocket balances & find other in-network healthcare providers.

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Provider Resources

Filing Claims

Submitting Claims Electronically

Balance prefers claims be submitted electronically.  For information, please call our Member Services.

Submitting Paper Claims

All paper claims must be submitted using a CMS 1500 form (for professional providers) and a UB-92 form (for institutional providers).

Send paper claims to:

Balance by CCHP
Claims Department
PO Box 1599
San Leandro, CA 94577

Balance Provider Dispute Process

Balance has a Provider Dispute Resolution (PDR) process that ensures provider disputes are handled in a fast, fair, and cost-effective manner.
A provider dispute is a written notice from a provider that:

  • Challenges, appeals, or requests for reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted, or contested
  • Challenges a request for reimbursement for an overpayment of a claim.
  • Seeks resolution of a billing determination or other contractual dispute.

How to Submit Provider Disputes

Providers must use a Provider Dispute Resolution and Appeal Request Form (PDF).

You may download Instructions for Submitting Provider Disputes (PDF) or call Balance Provider Dispute Relations at 1-628-228-3214 for assistance.

Disputes can be mailed to:

Balance by CCHP
Attn: Provider Dispute Resolution Area
445 Grant Avenue
San Francisco, CA 94108

Disputes can also be faxed to 1-415-955-8815.

Resolution Timeframe

Balance 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.

Prior Authorization for Medical Services

Contracting and non-contracting providers can contact Utilization Management at 1-877-208-4959 to request to obtain prompt authorization.

Provider Directory Updates

Please call, email, or submit the 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.

  1. Telephone: 1-628-228-3485
  2. Email: [email protected]
  3. Online Form

Plan Formulary & Pharmacy

A Balance plan drug list, a comprehensive formulary and a pharmacy locator can be found below under Drug List. 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.

(New) Prescription Drug Prior Authorization Request Form (PDF) (Uploaded 02/2018)

Drug List

Formulary for Individual, Family and Covered CA

Pharmaceutical Management Procedures (PDF)

Formulary (List of Covered Drugs) for Commercial Plans
(No changes made since 3/2024)

Pharmacy Directory – All Plans (PDF)
(No changes made since 4/2024)

Pharmacy Locator

Need More Help?

For general provider-based questions, such as:

  • General provider customer support
  • General utilization management inquiries
  • Data/analytics inquiries
  • Billing inquiries
  • Provider IT issues
  • General provider questions

Email us : provider.relations@

Any additional provider-based inquiries, such as:

  • Claim denial reason
  • Claim payment amount
  • EOP requests
  • Other provider inquiries

Email us: provider.relations@

Inquiries will be acknowledged within 5 business days, triaged, and sent to the appropriate team for review. Status updates will be provided for managed inquiries.

For verification issues on member eligibility:

Call us: 1-888-775-7888
TTY 1-877-681-8898

October 1 – March 31
7 days a week 8 a.m. – 8 p.m.

April 1 – September 30
Mondays – Fridays 8 am – 8 p.m.

Email us: memberservices@