Provider Manual

Why You Need the Manual

Your Provider Manual specifically addresses the contractual and regulatory requirements of Care1st. This manual is intended as a guideline for the provision of covered services to Care1st Health Plan Members. This manual contains policies, procedures and general reference information including minimum standards of care, which are required of Care1st Health Plan Providers. Following requirements defined in the manual ensures that our members receive comprehensive care.


Provider Manuals
MEDICARE Provider Manual

Provider Manual Updates:

  • Section 1
    Provider Network Operations (Rev. 6.30.15)
  • Section 3.3.3
    Provider Disputes (Rev. 9.24.14)
  • Section 5.1
    Utilization Management Program (Rev. 9.10.15)
  • Section 6.3
    Pharmaceutical Utilization Management (Rev. 9.14.17)
  • Section 7.9.1
    Access to Care Standards (Rev. 5.25.16)
  • Section 15
    Appendix 7 Primary Care Practitioners Access to Care Standards (PCPS) (Rev. 5.20.14)

Provider Manuals
MEDI-CAL Provider Manual

Provider Manual Updates:

  • Section 7.1.4
    UM Review Process for Appropriateness of Care (Rev. 9/10/2015)
  • Section 7.8.10
    Mental Health (Medi-Cal Managed Care) (Rev. 3/30/2015)
  • Section 7.8.22
    Services Under the End of Life Options Act (ABx2-15) (Rev. 12/12/2016)
  • Section 9.6
    Initial Health Assessment (IHA) (Rev. 10/17/2016)
  • Section 9.9.1
    Access to Care Standards (Rev. 5/9/2016)
  • Section 10.1
    Drug Formulary (Rev. 9/14/2017)
  • Section 12
    Provider Network Operations (Rev. 6/30/2015)
  • Section 12.8.5
    Provider Demographic Updates (Rev. 11/1/2016)
  • Section 17.2
    Identification of Limited English Proficient (LEP) Members (Rev. 5/20/2015)
  • Section 18
    Appendix 8 Primary Care Practitioners Access to Care Standards (PCPS) (Rev. 5/20/2014)

We'll Keep You Updated

From time to time we will need to update our website as our policies change, or as LA Care, CMS, and/or DHS requirements change. We will keep you informed of those changes as they occur. As a Care1st Provider, we hope this information will help you better understand how Care1st operates.

Additional Information

Although this manual contains a comprehensive summary of Care1st policies and procedures, additional protocols regarding plan administrative practices, full plan medical policies, and other detailed information are available to the provider upon request by calling Care1st Provider Relations Department at 1-323-889-6638.


California Department of Health Care Services

Instructions related to Transactions based on ASC X12 Implementation Guides, version 004050.

Health Care Provider Directory (EDI 274)
Standard Companion Guide Transaction Information

Health Care Provider Directory Flat File Version for EDI 274
Flat File Version for EDI 274 Provider Information