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Behavioral Health Plan and Provider Information

Medi-Cal Behavioral Health Plan - Provider Directory Website

MC BHP Handbook and Provider Directory Lobby Notice updated

Behavioral Health Plan Member Handbook

Small image of BH Member Handbook cover

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 BHP.

For general information and accessibility issues please call:

Orange County Behavioral Health Plan
Phone: 800-723-8641
For TTY/TDD users, call 711

updated

 

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This guide is available for listening in MP3 audio format in multiple languages.
About listening to files

Handbook Audio RecordingEnglishArabic Chinese (Simplified)Farsi Korean Russian Spanish Vietnamese  
September 2025 Update - DMC-ODS

English September 2025

new

Arabic September 2025

new

Coming Soon

 

Farsi September 2025

new

Korean September 2025

new

 

Coming Soon

 

Spanish September 2025

new

Vietnamese September 2025

new

 

  • September 2025 Update is regarding additional Substance Use Disorder Services available through the Drug Medi-Cal Organized Delivery System.

     

BH Provider Handbook Coding Manual 

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

 

Forms / Brochures

 

TitleArabicChineseEnglishFarsiKoreanRussianSpanishVietnamese
Advance Health Care Directives (F346-705)Acrobat Reader Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Grievance or Appeal Form (F346-706)
Grievance Tracking Form		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 (Russian)Grievance or Appeal Form (Spanish)Grievance or Appeal Form (Vietnamese)
Grievance & Appeal Process Posters *** UPDATED ***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 or Appeal Form (Russian)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Grievance Fact Sheet MHPGrievance 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 or Appeal Form (Russian)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Authorization to Use and Disclose Protected Health Information (F346-531B)Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Consent to Record (F346-474)  Adobe Acrobat Icon Adobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Mental Health Plan Intake/Advisement Checklist (F346-753)Adobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
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)

BHS Combined Informed and Telehealth Consent

new

Informed ConsentInformed ConsentInformed Consent Informed ConsentInformed Consent Informed ConsentInformed Consent Informed Consent
BHS Telehealth Email Acknowledgement FormInformed ConsentInformed ConsentInformed Consent Informed Consent Informed ConsentInformed Consent
AQIS Continuity of Care Request Form  Adobe Acrobat Icon     
National Voter Registration Act (NVRA) Preference Forms (County Operated Provider Use Only)
National Voter Registration FAQs		 NVRA FormsNVRA Forms NVRA Forms NVRA FormsNVRA Forms
Interpretation Services Poster  NVRA Forms     

Supervision Reporting Forms

Clinical Supervision Reporting Form
*** UPDATED ***		  NVRA Forms     
Clinical Supervisor Agreement (for County Programs only) *** NEW ***  NVRA Forms     
Medical Supervision Reporting Form
*** UPDATED ***		  Acrobat icon     

Qualified Provider Supervision Form *** NEW 3/2025 ***


MEMO: Qualified Provider Type *** NEW 2/2025 ***

  

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NOABD

Notice of Adverse Benefit Determination-Delivery SystemWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Modification NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Termination NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Denial Notice  Word Icon     
NOABD Member Non-Discrimination NoticeAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Notice of Adverse Benefit Determination-Your Rights Under Medi-CalWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Availability  Adobe Acrobat Icon     

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