BHS Medi-Cal Provider Information

 

Medi-Cal Mental Health Plan - Provider Directory


Medi-Cal Mental Health Plan - Provider Directory PDF - August 2021 
MC MHP Handbook and Provider Directory Lobby Notice

Consumer Handbook - Guide to Medi-Cal Mental Health Services

cover-medi-handbook

This guide will help you know what specialty mental health services are, if you may get them, and how you can get help from the Orange County MHP.

For general information and accessibility issues please call:

Orange County Mental Health Plan

Phone: 800-723-8641
For TTY/TDD users, call 711

 

cd-guide-to-medi-cal

This guide is also available (MP3 audio format) in multiple languages.
About listening to files

Sections Arabic English Farsi Korean Spanish Vietnamese
1. Medi-Cal Handbook County Section Part 1 (mp3) Part 1 (mp3)

Part 1 (mp3)

Part 1 (mp3) Part 1 (mp3) Part 1 (mp3)
2. Medi-Cal Handbook State Section Part 2 (mp3) Part 2 (mp3)

Part 2 (mp3)

Part 2 (mp3) Part 2 (mp3) Part 2 (mp3)

 

 

BH Provider Handbook Coding Manual 

Behavioral Health Provider Handbook Coding Manual Version 11 (November 2020)
(121 page pdf file)

 

Forms / Brochures

 

Title

Arabic

Chinese

English

Farsi

Korean

Spanish

Vietnamese

Advance Health Care Directives (F346-705)

 

Grievance or Appeal Form (F346-706)

Grievance or Appeal Form (Arabic)

Grievance or Appeal Form (Chinese)

Grievance or Appeal Form (English)

Grievance or Appeal Form (Farsi)

Grievance or Appeal Form (Korean)

Grievance or Appeal Form (Spanish)

Grievance or Appeal Form (Vietnamese)

Grievance & Appeal Process Posters

Grievance and Appeal Process Posters (Arabic)

Grievance and Appeal Process Posters (Chinese)

Grievance and Appeal Process Posters (English)

Grievance and Appeal Process Posters (Farsi)

Grievance and Appeal Process Posters (Korean)

Grievance and Appeal Process Posters (Spanish)

Grievance and Appeal Process Posters (Vietnamese)

Grievance Fact Sheet MHP    

Grievance and Appeal Process Posters (English)

   

Grievance and Appeal Process Posters (Spanish)

Grievance and Appeal Process Posters (Vietnamese)

Authorization to Use and Disclose Protected Health Information (F346-531B)

   

Consent to Record (F346-474)

 

 

 

Mental Health Plan Intake/Advisement Checklist (F346-753)

 

Psychiatric Medication Consent (F346-7921)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (Chinese)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (Spanish)

Psychotropic Medication Consent (English)

Informed Consent for Services - General (F346-301)

Informed Consent

 

Informed Consent

Informed Consent

Informed Consent

Informed Consent

Informed Consent

Informed Consent for Telehealth and Telephonic Services

Informed Consent - Telehealth

Informed Consent - Telehealth 
Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Telehealth Email Acknowledgement Form

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

 

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

Notice of Adverse Benefit Determination-Delivery System

Notice of Adverse Benefit Determination- Modification Notice

Notice of Adverse Benefit Determination- Termination Notice

NOABD Beneficiary Non--Discrimination Notice

 

Notice of Adverse Benefit Determination- Your Rights Notice

Language tagline

 

 

 

 

 

 

AQIS Continuity of Care Request Form    

       

National Voter Registration Act (NVRA) Preference Forms (County Operated Provider Use Only)
National Voter Registration FAQs

 

NVRA Forms

NVRA Forms

 

NVRA Forms

NVRA Forms

NVRA Forms

Car Seat Safety Flyers (County Operated Provider Use Only) 
Notice of Privacy Practices (NPP) (County Operated Provider Use Only) 
Patients' Rights Downloads

For information and resources about the Drug Medi-Cal Organized Delivery System (DMC-ODS), visit http://www.ochealthinfo.com/DMC-ODS