Provider Resources

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

View our Prior Authorization Process page for more information on the whole process.

Learn more on our Timely Access to Care page.

Our Complex Case Management Program is designed for members with multiple chronic conditions, particularly those with uncontrolled Type II diabetes (HbA1c ≥ 8.0%) and heart failure. Enrollment in this program will not affect your benefits. Members and providers are encouraged to complete this referral form for program consideration. Click here to learn more. 

Submitting Claims Electronically

• Balance prefers claims to be submitted electronically.  For assistance, contact 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
Attn: Claims Department
PO Box 1599
San Leandro, CA 94577

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 submit the Provider Dispute Resolution and Appeal Request Form.
• Download this Submitting Provider Disputes document for detailed instructions or call Balance Provider Dispute Relations at 1-628-228-3214.

Disputes can be mailed to:

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

OR 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.

Formulary (List of Covered Drugs) for Commercial Plans
(No changes made since 4/2026)

Pharmacy Directory (IFP & CCA)

Pharmacy Directory (EGP)
(No changes made since 10/2025)

Pharmaceutical Management Procedures

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

Effective July 1, 2014, the new Prescription Drug Prior Authorization Request Form is required for non-Medicare plans per DMHC regulations (Section 1300.67.241).

Download your very own copy of the Balance by CCHP Provider Manual – Revised 01/20/26.