Provider Resources

  • 20181108

    EZ-Cap / EZ-Net Core System Migration Notice

  • 20161208

    Utilization Management Independence Affirmation Memo to Network

  • 20180817

    Direct Referral Form

  • 20180726

    Pre-Authization/Referral Authorization Request Form

  • 20180614

    Provider Web Portal Application

  • 20170418

    Provider Demographic Info Change Request Form

  • 20170418

    W9

  • 20170109

    Provider Dispute Resolution Request

  • 20190102

    Urgent Care Centers

  • 20180921

    Access to Care Standards

  • 20160922

    Provider Quick Reference Sheet

  • 20171219

    Provider Manual

  • 20170703

    Fraud Waste and Abuse Training 2017

  • 20170703

    Fraud Waste and Abuse Training Attestation 2017

  • 20170427

    SNP MOC Attestation 2017

  • 20170427

    SNP MOC Training 2017

  • 20170331

    Provider Manual Acknowledgment Form

Contact Us

    • Imperial Health
    • 600 South Lake Avenue
    • Suite 308
    • Pasadena, CA 91106
    • Main
    • (626) 838-5100
    • Main Fax
    • (626) 521-6028
    • After Hours Nurse Line
    • (626) 838-5100
    • Utilization Management
    • (626) 838-5100 Option 1
    • Utilization Management Fax
    • (626) 283-5021
    • Claims Department
    • (626) 838-5100 Option 3
    • Claims Forwarding Address
    • P.O. Box 60075
      Pasadena, CA 91116
    • Claims Payer ID
      (Electronic Submission)
    • Office Ally: IHHMG
    • Member Services
    • (626) 838-5100 Option 2
    • Contracting Phone
    • (626) 838-5100 Option 4
    • Provider Services Phone
    • (626) 838-5100 Option 5
    • Eligibility
    • (626) 838-5100 Option 6
    • Contracting/ Provider Services Fax
    • (626) 380-9142
    • Credentialing Fax
    • (626) 380-9963