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.

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 12/2025)

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 07/29/25.