Drug Medi-Cal Organized Delivery System

Welcome to the County of San Diego’s Behavioral Health Services (BHS) Drug Medi-Cal Organized Delivery System (DMC-ODS) document library. From this site you will be able to access any communications, forms, and manuals that BHS has sent out to providers. If you are looking for more general information regarding DMC-ODS, please visit the BHS DMC-ODS website by clicking here.  

Training

If you are provider and are looking for a comprehensive list of required provider trainings for DMC-ODS, click here to visit the DMC-ODS Training site.

Questions & Answers Bank

BHS have put together a Questions and Answers website for purposes of DMC-ODS. Questions on the website are categorized by type (e.g. billing, outcomes, training etc.). In the event that you are unable to locate the answer to your question(s), please submit your question(s) to their DMC-ODS email inbox at Info-DMC-ODS.HHSA@sdcounty.ca.gov. Emails will be responded to as soon as possible. Click here to visit their Questions and Answers page.

SUDPOH

SUDURM

Name Description Date
* 00 – SUD Uniform Record Manual August 2018 (pdf)
2018-10-26
* 02 – Client File Order 8-7-18 (pdf)
2018-08-10
* 03 - Section 1 Detail (pdf)
2018-07-06
* 101a-1 Instruction DMC Client Tracking 7-18-18 (pdf)
2018-08-06
* 101a-2 DMC Client Tracking 7-18-18 (pdf)
2018-08-06
* 101b-1 County Billable (Non-DMC) Client Tracking 7-18-18 (pdf)
2018-08-06
* 101b-2 Instructions County Billable (Non-DMC) Client Tracking 7-18-18 (pdf)
2018-08-06
* 102a-1 Instruction QAR Initial Review Form 08-13-18 (pdf)
2018-08-14
* 102a-2 QAR Initial Review Form 08-01-18 (pdf)
2018-08-13
* 102b-1 Instruction QAR Extension-Stay-Discharge Form 08-13-18 (pdf)
2018-08-14
* 102b-2 SUD Extension QAR Review Form 08-10-18 (pdf)
2018-08-13
* 103 Instruction Medi-Cal Eligibility Printout 4-12-17 (pdf)
2017-05-01
* 104a Instruction Supplement Minor Children 04-12-17 (pdf)
2018-01-24
* 104a Minor Children Form 04-12-17 (pdf)
2018-01-24
* 104b-1 Instructions Brief ASAM Screening 6-27-18 (pdf)
2018-07-05
* 104b-2 Brief ASAM Screening Tool Hard Copy 6-27-18 (pdf)
2018-07-05
* 104b-3 Brief ASAM Screening Tool Form Fill 6-27-18 (pdf)
2018-07-05
* 104c-1 Instructions Adult Initial Level of Care Assessment 8-9-18 (pdf)
2018-08-13
* 104c-2 Adult Initial LOC Assessment Hard Copy 08-01-18 (pdf)
2018-08-13
* 104c-3 Adult Initial LOC Assessment Form Fill 08-01-18 (pdf)
2018-08-13
* 104d-1 Instructions Adolescent Initial LOC Assessment 8-9-18 (pdf)
2018-08-13
* 104d-2 Adolescent Initial LOC Assessment Hard Copy 8-9-18 (pdf)
2018-08-13
* 104d-3 Adolescent Initial LOC Assessment Form Fill 08-09-18 (pdf)
2018-08-13
* 104e-2 Parent Guardian Initial LOC Assessment Hard Copy 6-19-18 (pdf)
2018-07-05
* 104e-3 Parent Guardian Initial LOC Assessment Form Fill 08-02-18 (pdf)
2018-08-13
* 105 Placement Fee Collection 4-12-17 (pdf)
2017-05-01
* 106 Placement-ID-SS-Medi Cal Cards (pdf)
2018-07-06
* 107a Instruction Financial Responsibility and Info Form 4-12-17 (pdf)
2017-05-01
* 107b Financial Responsibility and Information Form (pdf)
2017-04-27
* 108 Instruction CalOMS Profile rev 6-30-18 (pdf)
2018-07-06
* 108a CalOMS Profile rev 6-30-18 (pdf)
2018-07-06
* 108b CalOMS Profile Collateral Contacts rev 5-18 (pdf)
2018-07-06
* 109 Instructions SanWITS Contact Rev 6-30-18 (pdf)
2018-07-06
* 109a CalOMS Contact rev 6-30-18 (pdf)
2018-07-06
* 110 Instruction SanWITS Intake rev 6-30-18 (pdf)
2018-07-06
* 110a SanWITS Intake rev 6-30-18 (pdf)
2018-07-06
* 111 Instruction CalOMS Admission rev 6-30-18 (pdf)
2018-07-06
* 111a CalOMS Admission 6-30-18 (pdf)
2018-07-06
* 112 Instruction CalOMS Annual Update rev 6-30-18 (pdf)
2018-07-06
* 112a CalOMS Annual Update 7-1-18 (pdf)
2018-07-06
* 113 Instruction SanWITS Encounter (pdf)
2018-07-06
* 113a CalOMS Encounter rev 7-1-18 (pdf)
2018-07-06
* 200 Section 2 Detail 7-3-18 (pdf)
2018-07-06
* 201 Placement-consent to release 4-12-17 (pdf)
2017-05-01
* 202 Placement-Admissions Agreement-Consent to Treatment 4-12-17 (pdf)
2017-05-01
* 203a Instructions Personal Rights At An AOD Certified Program 7-26-18 (pdf)
2018-08-10
* 203b Personal Rights At An AOD Certified Program 7-26-18 (pdf)
2018-08-10
* 204 Placement-42 CFR Written Summary Requirements 7-2-18 (pdf)
2018-07-06
* 205 Placement-Notice of Privacy-HIPAA 4-12-17 (pdf)
2017-05-01
* 206 Placement-Consent to Follow up 4-12-17 (pdf)
2017-05-01
* 207 Placement-Consent for photo-tv-video 4-12-17 (pdf)
2017-05-01
* 208 Instruction Coordination of Care 4-12-17 (pdf)
2017-05-01
* 208a Coordination of Physical Behavioral Health (pdf)
2017-05-01
* 208b Form Fill Coordination of Physical Behavioral Health (doc)
2017-05-01
* 209a Instructions Acknowledgement of DMC-ODS Beneficiary Handbook and Provider Directory 6-27-18 (pdf)
2018-07-06
* 209b Acknowledgement of DMC-ODS Beneficiary Handbook and Provider Directory 10-25-18 (pdf)
2018-10-26
* 209b Acknowledgement of DMC-ODS Beneficiary Handbook and Provider Directory 6-27-18 (pdf)
2018-07-06
* 210a Instructions SUD Program Admission Checklist 6-27-18 (pdf)
2018-07-06
* 210b SUD Program Admission Checklist 6-27-18 (pdf)
2018-07-06
* 300 Section 3 Detail 7-3-18 (pdf)
2018-07-06
* 301a Instruction Stay Review 08-01-18 (pdf)
2018-08-10
* 301b Stay Review Form Hard Copy 08-01-18 (pdf)
2018-08-10
* 301c Stay Review Form Fill 08-01-18 (pdf)
2018-08-10
* 302a Instruction Alcohol and Drug Hx 4-12-17 (pdf)
2017-05-01
* 302b Alcohol and Drug History Form 4-12-17 (pdf)
2017-05-01
* 303a Instruction ASI-YAI 4-12-17 (pdf)
2017-05-01
* 303c ASI Lite (pdf)
2017-04-27
* 303d YAI (pdf)
2018-09-11
* 304a Instruction Co-occurring Form 4-12-17 (pdf)
2017-05-01
* 304b Co-occurring Screening Form 4-12-17 (pdf)
2017-04-27
* 304c Form Fill Co-occurring Screening Form 4-12-17 (doc)
2017-04-27
* 305a Instruction HRA (pdf)
2018-02-01
* 305b High Risk Assessment 4-12-17 (pdf)
2017-05-01
* 305c Form Fill High Risk Assessment 4-12-17 (docx)
2017-05-01
* 305d Instruction HRI 4-12-17 (pdf)
2017-05-01
* 305e High Risk Index 4-12-17 (pdf)
2017-05-01
* 305f Form Fill High Risk Index 4-12-17 (docx)
2017-05-01
* 306a Instructions ASAM Level of Care Recommendation 6-27-18 (pdf)
2018-07-06
* 306b ASAM LOC Recommendation 6-11-18 (pdf)
2018-07-06
* 307a Instructions Assessment Summary (pdf)
2018-07-06
* 307b Assessment Summary 06-26-18 (pdf)
2018-07-06
* 307c Assessment Summary Form Fill 06-26-18 (pdf)
2018-07-06
* 308a Instructions Diagnosis Determination Note 8-7-18 (pdf)
2018-08-10
* 308b Dx Determination Note 06-26-18 (pdf)
2018-07-06
* 308c Dx Determination Note Form Fill 06-26-18 (pdf)
2018-07-06
* 400 Section 4 Detail 7-3-18 (pdf)
2018-07-06
* 401a Instruction WM Observation Log 9-25-18 (pdf)
2018-10-11
* 401b WM Observation Log 9-25-18 (pdf)
2018-10-11
* 402a Instruction Centrally Stored Medication & Destruction Record 4-12-17 (pdf)
2018-07-06
* 402b Centrally Stored Medication and Destruction Record (pdf)
2017-04-27
* 403a Instruction Health Questionnaire Form 9-30-18 (pdf)
2018-10-11
* 403b Health Questionnaire 09-25-18 (pdf)
2018-10-11
* 404a Instruction TB questionnaire 4-12-17 (pdf)
2017-05-01
* 404b TB screening form 4-12-17 (pdf)
2017-05-01
* 406 Instruction Physician Direction form 4-12-17 (pdf)
2017-05-01
* 406 Physician Direction Form 4-12-17 (pdf)
2017-05-01
* 407 MD Recomendation to client 4-12-17 (pdf)
2017-05-01
* 408 placement-proof of pregnancy 4-12-17 (pdf)
2017-05-01
* 500 Section 5 Detail (pdf)
2018-03-09
* 501a Instructions Initial Treatment Plan 8-1-18 (pdf)
2018-08-10
* 501b Initial Treatment Plan 08-02-18 (pdf)
2018-08-10
* 502a Instructions Updated Treatment Plan 08-01-18 (pdf)
2018-08-10
* 502b Updated Treatment Plan 08-06-18 (pdf)
2018-08-10
* 503a Instructions Treatment Plan Addendum (pdf)
2018-07-06
* 503b Treatment Plan Addendum 6-11-18 (pdf)
2018-07-09
* 600 Section 6 Detail (pdf)
2018-07-06
* 601a Instructions SUD Treatment Progress Note 6-27-18 (pdf)
2018-07-06
* 601b SUD Treatment Progress Note - Hard Copy 06-21-18 (pdf)
2018-07-06
* 601c SUD Treatment Progress Note - Form Fill 07-13-18 (pdf)
2018-07-13
* 602a-1 Instructions for Residential Weekly Progress Note - Narrative 9-7-18 (pdf)
2018-09-11
* 602a-2 Weekly Progress Note Residential - Narrative - Hard Copy 6-27-18 (pdf)
2018-07-06
* 602a-3 Weekly Progress Note Residential - Narrative - Form Fill 6-27-18 (pdf)
2018-07-06
* 602b-1 Instructions for Residential Weekly Progress Note - Services 9-7-18 (pdf)
2018-09-11
* 602b-2 Weekly Progress Note Residential - Services 06-19-18 (pdf)
2018-07-06
* 603a Instructions Residential WM Daily Progress Note 10-5-18 (pdf)
2018-10-11
* 603b Residential WM Daily Progress Note – Hard Copy 10-05-18 (pdf)
2018-10-11
* 603c Residential WM Daily Progress Note Form Fill 10-03-18 (pdf)
2018-10-11
* 700 Section 7 Detail 7-3-18 (pdf)
2018-07-06
* 701a Instructions Discharge Summary 7-05-18 (pdf)
2018-07-06
* 701b Discharge Summary - Hard Copy 07-05-18 (pdf)
2018-07-06
* 701c Discharge Summary -Form Fill 06-13-18 (pdf)
2018-07-06
* 703a Instruction CalOMS Discharge rev 7-1-18 (pdf)
2018-07-09
* 703b CalOMS Discharge rev 7-1-18 (pdf)
2018-07-09
* 704a Instruction Client Discharge Plan 4-12-17 (pdf)
2017-05-01
* 704b Client Discharge Plan 4-12-17 (pdf)
2017-04-27
* 704c Form Fill Client Discharge Plan 4-12-17 (docx)
2017-05-01
* 800 Section 8 Detail 7-3-18 (pdf)
2018-07-06
* 801a Instruction Drug Test and Results Log (pdf)
2017-05-01
* 801b Drug Test and Result Log Form (pdf)
2017-05-01
* 802 placement Drug Test Results From Lab 4-12-17 (pdf)
2017-05-01
* 803 placement Progress Reports (pdf)
2017-05-01
* 804 placement Case Management Notes-Plans (pdf)
2017-05-01
* 805 placement Referral Source Documents (pdf)
2017-05-01
* 806a FAX COVER SHEET FOR RSUD AUTH (docx)
2018-08-02
* 806b FAX COVER SHEET FOR RSUD AUTH Form Fill (pdf)
2018-08-02

Communications

Name Description Date
* Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process.pdf
2018 04/05 Issued 2018-06-06
* Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process - Attachment 2.xlsx
2018 04/05 Issued 2018-06-06
* Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process - Attachment 3.xlsx
2018 04/05 Issued 2018-06-06
* Info Notice - FY 17-18 Start-up Cost Amendment.pdf
2018 01/12 Issued 2018-06-06
* Info Notice - FY 17-18 Start-up Cost Amendment - Attachment 1.xlsx
2018 01/12 Issued 2018-06-06
* Info Notice - FY 17-18 Start-up Cost Amendment - Attachment 2.xlsx
2018 01/12 Issued 2018-06-06
* Info Notice - Start-up Enhancements for FY 17-18 and FY 17-18.pdf
2018 01/31 Issued 2018-06-06
* Info Notice - Start-up Enhancements for FY 17-18 and FY 17-18 - Attachment 1.xlsx
2018 01/31 Issued 2018-06-06
* Letter - Preparing for Contracting under the DMC-ODS.pdf
2017 10/24 Issued 2018-06-06
* Letter - Updates on the BHS DMC-ODS Implementation.pdf
2017 01/07 Issued 2018-06-06
* Info Notice - DMC-ODS Court Ordered Residential Treatment.pdf
2018 05/17 Issued 2018-06-06
* Info Notice - DMC-ODS Training Requirements and Waiver Resources.pdf
2018 03/19 Issued 2018-06-06
* Info Notice - DMC-ODS Court Ordered Residential Treatment - Follow-Up.pdf
2018 06/12 Issued 2018-06-12
* Info Notice - Reentry and Drug Courts SUD Treatment Services.pdf
2018 06/13 Issued 2018-06-15
* Compliance Bulletin #30 - Cloned Documentation - 11-1017 (pdf)
2011 10/17 Issued 2018-12-06
* Email - ASAM Training Log Update Request and New ASAM C Training on July 18, 2018
2018 06/25 Emailed 2018-07-09
* Email - BHS 2018-014: Timely Admissions for Collaborative Court Participants (pdf)
2018 10/12 Emailed 2018-10-19
* Email - DMC-ODS SUDPOH Overview on June 14, 2018 - Questions and Answers (pdf)
2018 06/29 Emailed 2018-07-09
* Email - Updated SUDURM Forms Effective July 1, 2018 (pdf)
2018 06/27 Emailed 2018-07-09
* Email – SUD Providers – County Billable Services for July 2018 (pdf)
2018 07/13 Emailed 2018-10-02
* Email – SUD Providers – Extension of Transition Plan (County Billable Services) (pdf)
2018 07/23 Emailed 2018-10-04
* Info Notice - DMC-ODS Twice-a-Month Invoice Process (pdf)
2018 07/02 Issued 2018-07-09
* Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process - Attachment 1 (pdf)
2018 05/17 Issued 2018-06-06
* Info Notice - Process for Out-of-County Clients (pdf)
2018 07/30 Issued 2018-08-06
* Info Notice - Rate Cap Waiver Extension (pdf)
2018 09/19 Emailed 2018-10-02
* Info Notice - Rate Cap Waiver for First Quarter (Q1) (pdf)
2018 08/07 Issued 2018-08-09
* Info Notice - Timely Access to Services (pdf)
2018 07/31 Issued 2018-08-06
* Info Notice – BHS 2018-014 Timely Admissions for Collaborative Court Participants (pdf)
2018 10/19 Issued 2018-10-26
* Initial Billing Compliance Reviews (pdf)
2018-09-26
* Memo - DMC-ODS Travel Time Guidelines
2018 07/05 Issued 2018-07-09
* Memo - QI SUD Provider Updates (pdf)
2018 08/16 Issued 2018-08-22
* Memo – Assessed No Admit and Assess Delayed Admit 10-18 (pdf)
2018 10/19 Issued 2018-10-26
* Memo – Patient Advocacy Services for BHS – Record Requests (pdf)
2018 10/31 Emailed 2018-11-02

QM Training

Manuals

Name Description Date
* Special Terms and Conditions - Amended Apr 5 2018.pdf
Updated Apr 5 2018 2018-06-21
* County of San Diego DMC-ODS Implementation Plan.pdf
* County of San Diego DMC-ODS Implentation Plan Appendix.pdf
* County of San Diego DMC-ODS Intergovernmental Agreement Contract.pdf
2018-09-13
* County of San Diego DMC-ODS Interim Rate Caps.pdf
* DHCS AOD Program Certification Standards (pdf)
Updated May 1, 2017 2018-09-06
* DHCS Perinatal Practice Guidelines FY18-19 (pdf)
Updated September 20, 2018 2018-09-27
* DHCS Youth Treatment Guidelines (pdf)
Updated August 2002 2018-09-27
* DMC-ODS Provider Services Guide (pdf)
2018-09-10

ASAM

Toolbox

Name Description Date
* One-Pager - Case Management in the DMC-ODS.pdf
Updated Jun 8 2018 2018-06-12
* One-Pager - DMC-ODS Required Policies and Procedures.pdf
Updated Jun 8 2018 2018-06-12
* One-Pager - Programs with Multiple Contracts.pdf
Updated May 14 2018 2018-06-15
* One-Pager - Recovery Services in the DMC-ODS.pdf
Updated Oct 17 2017 2018-06-15
* ASAM Level of Care Guidelines (pdf)
2018-11-08
* In-custody SUD Tx Self-Referral form 10-16-18 (pdf)
2018-10-26
* One-Pager - General Outpatient Tx Assumptions (pdf)
Sept 17 2018 2018-09-21
* One-Pager - General Residential Tx Assumptions (pdf)
Sept 17 2018 2018-09-21
* One-Pager - Medical Director in DMC-ODS (pdf)
2018-07-05
* One-Pager - Recovery Residences – Supplemental Funding Guidelines (pdf)
Sept 17 2018 2018-09-21
* One-Pager DMC-ODS Documentation Changes (pdf)
Updated Jun 18 2018 2018-06-20
* Quick Guide - Case Management Activities (pdf)
Updated May 14 2018 2018-06-20
* Quick Guide - DMC-ODS Client Flow Process (pdf)
2018-09-10
* Quick Guide - DSM5-ICD10 Diagnosis Guide (pdf)
Updated Jun 12 2018 2018-06-22
* Quick Guide - Minimum Quality Drug Treatment Standards for DMC/SABG (pdf)
Updated Jun 12 2018 2018-06-22
* Quick Guide - Outpatient Due Dates (pdf)
2018-08-10
* Quick Guide - Residential Due Dates (pdf)
2018-08-10
* Quick Guide - Residential Services (pdf)
2018-08-14
* Quick Guide - SUD Residential Clinical Documentation and Authorization (pdf)
Updated May 14 2018 2018-06-20
* Quick Guide - Same Day Billing Matrix (pdf)
Updated Jun 19 2018 2018-06-22

Beneficiary

Name Description Date
* Beneficiary Handbook - English.pdf
For use after Jul 1 2018 2018-06-15
* Beneficiary Handbook - English - Large Print.pdf
For use after Jul 1 2018 2018-06-15
* Audio Quick Guide - DMC-ODS Services in San Diego - Arabic.mp3
For use after Jul 1 2018 2018-06-20
* Audio Quick Guide - DMC-ODS Services in San Diego - English.mp3
For use after Jul 1 2018 2018-06-20
* Audio Quick Guide - DMC-ODS Services in San Diego - Farsi.mp3
For use after Jul 1 2018 2018-06-20
* Audio Quick Guide - DMC-ODS Services in San Diego - Spanish.mp3
For use after Jul 1 2018 2018-06-20
* Audio Quick Guide - DMC-ODS Services in San Diego - Tagalog.mp3
For use after Jul 1 2018 2018-06-20
* Audio Quick Guide - DMC-ODS Services in San Diego - Vietnamese.mp3
For use after Jul 1 2018 2018-06-20
* Quick Guide - DMC-ODS Services in San Diego - Arabic.pdf
For use after Jul 1 2018 2018-06-28
* Quick Guide - DMC-ODS Services in San Diego - English.pdf
For use after Jul 1 2018 2018-06-28
* Quick Guide - DMC-ODS Services in San Diego - Farsi.pdf
For use after Jul 1 2018 2018-06-28
* Quick Guide - DMC-ODS Services in San Diego - Spanish.pdf
For use after Jul 1 2018 2018-06-28
* Quick Guide - DMC-ODS Services in San Diego - Tagalog.pdf
For use after Jul 1 2018 2018-06-28
* Quick Guide - DMC-ODS Services in San Diego - Vietnamese.pdf
For use after Jul 1 2018 2018-06-28
* Brochure - Grievance and Appeal Process - English.pdf
For use after Jul 1 2018 2018-06-29
* Poster - Grievance and Appeal - English.pdf
For use after Jul 1 2018 2018-06-29
* Brochure – Grievance and Appeal Process 6-28-18 Arabic (pdf)
2018-08-15
* Brochure – Grievance and Appeal Process 6-28-18 Farsi (pdf)
2018-08-15
* Brochure – Grievance and Appeal Process 6-28-18 Spanish (pdf)
2018-08-15
* Brochure – Grievance and Appeal Process 6-28-18 Tagalog (pdf)
2018-08-15
* Brochure – Grievance and Appeal Process 6-28-18 Vietnamese (pdf)
2018-08-15
* DMC-ODS Beneficiary Packet Order Form rev 10-22-18 (pdf)
2018-10-26
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Arabic (docx)
2018-08-15
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 English (docx)
2018-06-29
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Farsi (docx)
2018-08-15
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Spanish (docx)
2018-08-15
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Tagalog (docx)
2018-08-15
* Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Vietnamese (docx)
2018-08-15
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 Arabic (docx)
2018-08-15
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 English (docx)
For use after Jul 1 2018 2018-06-29
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 Farsi (docx)
2018-08-15
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 Spanish (docx)
2018-08-15
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 Tagalog (docx)
2018-08-15
* Form – Client Grievance or Appeal – JFS Residential 6-28-18 Vietnamese (docx)
2018-08-15
* Poster – Grievance and Appeal 6-28-18 Arabic (pdf)
2018-08-15
* Poster – Grievance and Appeal 6-28-18 Farsi (pdf)
2018-08-15
* Poster – Grievance and Appeal 6-28-18 Spanish (pdf)
2018-08-15
* Poster – Grievance and Appeal 6-28-18 Tagalog (pdf)
2018-08-15
* Poster – Grievance and Appeal 6-28-18 Vietnamese (pdf)
2018-08-15
* Poster – Grievance and Appeal English LARGE FONT 7-12-18 (pdf)
2018-08-15
* Quick Guide - How To Apply for Medi-Cal (pdf)
2018-11-27

NOABD

Name Description Date
* NAR Adverse Benefit Determination Upheld Notice - FARSI.doc
- 2018-08-07
* NOABD Grievance and Appeal Timely Resolution Notice - SPANISH.doc
- 2018-08-07
* NOABD Payment Denial Notice - SPANISH.docx
- 2018-08-07
* NOABD Modification Notice - SPANISH.doc
- 2018-08-07
* NOABD Authorization Delay Notice - ENGLISH.doc
- 2018-08-07
* NOABD Your Rights Notice - VIETNAMESE.doc
- 2018-08-07
* NAR Your Rights State Hearing - ARABIC.doc
- 2018-08-07
* NAR Your Rights State Hearing - TAGALOG.docx
- 2018-08-07
* NOABD Authorization Delay Notice - SPANISH.doc
- 2018-08-07
* NAR Adverse Benefit Determination Upheld Notice - SPANISH.doc
- 2018-08-07
* NOABD Financial Liability Notice - ENGLISH.doc
- 2018-08-07
* NOABD Language Assistance Notice - ENGLISH.doc
- 2018-08-07
* NOABD Payment Denial Notice - ENGLISH.docx
- 2018-08-07
* NOABD Timely Access Notice - ARABIC.doc
- 2018-08-07
* NOABD Grievance and Appeal Timely Resolution Notice - TAGALOG.docx
- 2018-08-07
* Notice of Grievance Resolution - ARABIC.doc
- 2018-08-07
* NOABD Timely Access Notice - SPANISH.doc
- 2018-08-07
* NOABD Denial Notice - VIETNAMESE.doc
- 2018-08-07
* NAR Your Rights State Hearing - TAGALOG.pdf
- 2018-08-07
* NOABD Your Rights Notice - TAGALOG.docx
- 2018-08-07
* NOABD Your Rights Notice - SPANISH.doc
- 2018-08-07
* NOABD Timely Access Notice - TAGALOG.docx
- 2018-08-07
* Beneficiary Non-Discrimination Notice - SPANISH.pdf
2018-08-06
* NOABD Grievance and Appeal Timely Resolution Notice - ENGLISH.doc
- 2018-08-07
* NOABD Modification Notice - ENGLISH.doc
- 2018-08-07
* NOABD Grievance and Appeal Timely Resolution Notice - ARABIC.doc
- 2018-08-07
* Notice of Grievance Resolution - FARSI.doc
- 2018-08-07
* NOABD Denial Notice - ENGLISH.doc
- 2018-08-07
* NOABD Authorization Delay Notice - TAGALOG.docx
- 2018-08-07
* NAR Your Rights State Hearing - ENGLISH.pdf
- 2018-08-07
* NOABD Denial Notice - FARSI.doc
- 2018-08-07
* NOABD Termination Notice - ARABIC.doc
- 2018-08-07
* NAR Your Rights State Hearing - FARSI.pdf
- 2018-08-07
* NOABD Modification Notice - ARABIC.doc
- 2018-08-07
* NAR Adverse Benefit Determination Overturned Notice - TAGALOG.docx
- 2018-08-07
* NOABD Payment Denial Notice - ARABIC.docx
- 2018-08-07
* Notice of Grievance Resolution - TAGALOG.docx
- 2018-08-07
* NAR Your Rights State Hearing - ARABIC.pdf
- 2018-08-07
* NOABD Modification Notice - FARSI.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - VIETNAMESE.doc
2018-08-06
* NAR Your Rights State Hearing - SPANISH.doc
- 2018-08-07
* NOABD Financial Liability Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Denial Notice - SPANISH.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - TAGALOG.docx
2018-08-06
* NOABD Your Rights Notice - ARABIC.doc
- 2018-08-07
* NOABD Your Rights Notice - VIETNAMESE.pdf
- 2018-08-07
* NOABD Your Rights Notice - FARSI.pdf
- 2018-08-07
* Notice of Grievance Resolution - ENGLISH.doc
- 2018-08-07
* NOABD Grievance and Appeal Timely Resolution Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Language Assistance Notice - ENGLISH.pdf
- 2018-08-07
* NAR Your Rights State Hearing - VIETNAMESE.doc
- 2018-08-07
* NOABD Your Rights Notice - ENGLISH.doc
- 2018-08-07
* NOABD Your Rights Notice - SPANISH.pdf
- 2018-08-07
* NOABD Financial Liability Notice - FARSI.doc
- 2018-08-07
* NAR Adverse Benefit Determination Overturned Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Timely Access Notice - ENGLISH.doc
- 2018-08-07
* NAR Your Rights State Hearing - VIETNAMESE.pdf
- 2018-08-07
* Notice of Grievance Resolution - VIETNAMESE.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - FARSI.pdf
2018-08-06
* NAR Your Rights State Hearing - FARSI.doc
- 2018-08-07
* NAR Adverse Benefit Determination Overturned Notice - SPANISH.doc
- 2018-08-07
* NAR Adverse Benefit Determination Upheld Notice - TAGALOG.docx
- 2018-08-07
* NAR Adverse Benefit Determination Overturned Notice - FARSI.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - TAGALOG.pdf
2018-08-06
* NAR Your Rights State Hearing - SPANISH.pdf
- 2018-08-07
* NAR Adverse Benefit Determination Upheld Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Termination Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Termination Notice - SPANISH.doc
- 2018-08-07
* NOABD Termination Notice - ENGLISH.doc
- 2018-08-07
* NOABD Termination Notice - TAGALOG.docx
- 2018-08-07
* NOABD Payment Denial Notice - VIETNAMESE.docx
- 2018-08-07
* NOABD Modification Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Modification Notice - TAGALOG.docx
- 2018-08-07
* NOABD Payment Denial Notice - TAGALOG.docx
- 2018-08-07
* NOABD Financial Liability Notice - SPANISH.doc
- 2018-08-07
* NOABD Timely Access Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Your Rights Notice - ENGLISH.pdf
- 2018-08-07
* NAR Adverse Benefit Determination Upheld Notice - ENGLISH.doc
- 2018-08-07
* NOABD Timely Access Notice - FARSI.doc
- 2018-08-07
* NOABD Authorization Delay Notice - FARSI.doc
- 2018-08-07
* NOABD Grievance and Appeal Timely Resolution Notice - FARSI.doc
- 2018-08-07
* NOABD Your Rights Notice - TAGALOG.pdf
- 2018-08-07
* NOABD Your Rights Notice - ARABIC.pdf
- 2018-08-07
* NAR Adverse Benefit Determination Upheld Notice - ARABIC.doc
- 2018-08-07
* NOABD Denial Notice - TAGALOG.docx
- 2018-08-07
* NOABD Authorization Delay Notice - ARABIC.doc
- 2018-08-07
* NAR Adverse Benefit Determination Overturned Notice - ENGLISH.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - FARSI.doc
2018-08-06
* NOABD Payment Denial Notice - FARSI.docx
- 2018-08-07
* NOABD Authorization Delay Notice - VIETNAMESE.doc
- 2018-08-07
* NOABD Financial Liability Notice - TAGALOG.docx
- 2018-08-07
* NOABD Your Rights Notice - FARSI.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - SPANISH.doc
2018-08-06
* Beneficiary Non-Discrimination Notice - ARABIC.pdf
2018-08-06
* NOABD Denial Notice - ARABIC.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - VIETNAMESE.pdf
2018-08-06
* NAR Adverse Benefit Determination Overturned Notice - ARABIC.doc
- 2018-08-07
* NOABD Financial Liability Notice - ARABIC.doc
- 2018-08-07
* NOABD Termination Notice - FARSI.doc
- 2018-08-07
* Notice of Grievance Resolution - SPANISH.doc
- 2018-08-07
* NAR Your Rights State Hearing - ENGLISH.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - ARABIC.doc
2018-08-06
* Beneficiary Non-Discrimination Notice - ENGLISH.doc
- 2018-08-07
* Beneficiary Non-Discrimination Notice - ENGLISH.pdf
2018-08-07

UTTM

For versions of the UTTM prior to September 2018, please see the “UTTM” tab on the Organizational Provider Public Documents page.
Name Description Date
* SUD Up to the Minute - November 2018 (pdf)
2018-12-06
* SUD Up to the Minute - October 2018 (pdf)
2018-10-15
* SUD Up to the Minute - September 2018 (pdf)
2018-09-12 2018-09-20

SanWITS

Name Description Date
* CalOMS Tx Data Collection Guide Jan 2014 (pdf)
2018-09-12
* CalOMS Tx Data Dictionary April 2018 (pdf)
2018-09-12
* DATAR Web Manual April 2014 (pdf)
2018-09-12
* SanWITS Flow Assessed – Delayed Admit (pdf)
2018-10-26
* SanWITS Flow Assessed – No Admit (pdf)
2018-10-26
* SanWITS Flow – Group List for OTP Providers (pdf)
2018-11-02
* SanWITS Flow – Group List for Outpatient Providers (pdf)
2018-11-02
* SanWITS User’s Guide 2018 (pdf)
Updated September 25, 2018 2018-10-02

Billing

Name Description Date
* BHS Drug Medi-Cal Organizational Providers Billing Manual.pdf
Updated Jun 18 2018 2018-06-21
* DHCS Drug Medi-Cal Billing Manual (pdf)
Updated June 2017 2018-09-06
* OTP Billing SanWITS Screens 11-21-2018 (pdf)
2018-12-06
* Outpatient Billing SanWITS Screens 11-21-2018 (pdf)
2018-12-06
* PGE or Benefit Plan Review Billing Tip Sheet 11-19-2018 (pdf)
2018-12-06
* Residential Bed Day billing SanWITS Screens 11-21-2018 (pdf)
2018-12-06
* Residential Billing Case Management-Recovery Services SanWITS Screens 11-21-2018 (pdf)
2018-12-06