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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.

If you have questions regarding Training for SanWITS, a tips and resources page is now available for providers and Program Managers.

SUDPOH

1 – SUDPOH (pdf)
Revised 02/02/2024 2024-04-08
2 – Summary of Changes (pdf)
Revised 02/02/2024 2024-04-08

SUDURM

00 – SUD Uniform Record Manual 07-01-19 (pdf)
2019-09-03
001 – SUDURM Summary of Changes December 2023 (pdf)
Effective 1, 2024 2024-01-11
01 – Uniform Record Manual 07-01-19 (pdf)
Revised July 2019 2019-07-31
02 - Client File Order (pdf)
Revised December 2020 2020-12-23
03 - Section 1 Detail 01-14-19 (pdf)
2019-02-11
101a Instruction Client Tracking (pdf)
Revised December 2020 2020-12-23
101b Client Tracking (pdf)
Revised December 2020 2020-12-23
103 Instruction Medi-Cal Eligibility Printout (pdf)
2019-02-11
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 Screening Tool (pdf)
Revised December 2023 2024-01-11
104b-2 Brief Level of Care Screening Tool (pdf)
Revised December 2023 2024-01-11
104d-1 Instructions Adolescent Initial Level of Care Assessment (pdf)
Revised December 2023 2024-01-11
104d-2 Adolescent Initial LOC Assessment (pdf)
Revised December 2023 2024-01-11
104e-1 Instructions Parent Guardian Initial Level of Care Assessment (pdf)
Revised December 2020 2020-12-23
104e-2 Parent Guardian Initial LOC Assessment Hard Copy (pdf)
Revised December 2020 2020-12-23
104e-3 Parent Guardian Initial LOC Assessment Form Fill (pdf)
Revised December 2020 2020-12-23
105 Placement Fee Collection 4-12-17 (pdf)
2017-05-01
105a Instructions Adult ASAM Criteria Assessment (pdf)
Revised December 2023 2024-01-11
105b ASAM Criteria Assessment (pdf)
Revised December 2023 2023-03-07
106 Placement-ID-SS-Medi Cal Cards (pdf)
2018-07-06
107a Instruction Financial Responsibility Info and MC SOC 05-01-2020 (pdf)
Revised May 2020 2020-05-14
107b Financial Responsibility Information and MC SOC 05-01-2020 (pdf)
Revised May 2020 2020-05-14
108 Placement - SanWITS Admission Profile 01-14-19 (pdf)
2019-02-11
200 Section 2 Detail 07-01-19 (pdf)
2019-07-26
201 Placement-consent to release 07-01-19 (pdf)
2019-07-26
202 Placement-Admissions Agreement-Consent to Treatment 4-12-17 (pdf)
2017-05-01
203a Instructions Client Rights and Complaints 05-01-2020 (pdf)
Revised May 2020 2020-05-14
203b Client Rights and Complaints (pdf)
Revised December 2023 2024-01-05
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
209b Acknowledgement of DMC-ODS Handbook Practice Guidelines and Provider Directory (pdf)
Revised December 2023 2024-01-05
210a Instructions SUD Program Admission Checklist 6-27-18 (pdf)
2018-07-06
210b SUD Program Admission Checklist (pdf)
Revised November 2022 2022-11-11
300 Section 3 Detail 7-3-18 (pdf)
2018-07-06
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 01-11-19 (pdf)
2019-02-11
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-1 Instruction Risk Assessment and Safety Management Plan 06-06-19 (pdf)
Revised 06-06-19 2019-07-22
305a-2 Risk Assessment and Safety Management Plan 06-06-19 (pdf)
2019-07-22
305b-1 Instruction High Risk Assessment 06-06-19 (pdf)
Revised 06-06-19 2019-07-22
305b-2 High Risk Assessment 06-06-19 (pdf)
2019-07-22
307a Instructions Assessment Summary 01-11-19 (pdf)
2019-02-11
307b Assessment Summary 06-26-18 (pdf)
2018-07-06
307c Assessment Summary Form Fill 06-26-18 (pdf)
2018-07-06
400 Section 4 Detail 01-14-19 (pdf)
2019-02-11
401a Instruction WM Observation Log 11-26-19 (pdf)
2019-12-02
401b Withdrawal Observation Log 11-21-19 (pdf)
2019-12-02
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
403 Placement – Health Questionnaire 07-07-2022 (pdf)
2022-08-02
404a Instruction TB questionnaire 01-11-19 (pdf)
2019-02-11
404b TB screening form 4-12-17 (pdf)
2017-05-01
406 Instruction Physician Direction Form (pdf)
Revised 2022 2022-10-10
406 Physician Direction Form 09-2022 (pdf)
Revised 09/2022 2022-10-10
407 MD Recomendation to client 4-12-17 (pdf)
2017-05-01
407a Placement - Physical Exam Results 05-01-2020 (pdf)
Revised May 2020 2020-05-14
408 Placement - Proof of Pregnancy 01-11-19 (pdf)
2019-02-11
500 Section 5 Detail 01-14-19 (pdf)
2019-02-11
501a Instructions Problem List (pdf)
Revised December 2023 2024-01-05
501b Problem List (pdf)
Revised August 2022 2022-08-12
505a Instructions Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
505b Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
600 Section 6 Detail 01-15-19 (pdf)
2019-02-11
601a Instructions SUD Treatment Progress Note (pdf)
Revised December 2023 2024-01-08
601b SUD Treatment Progress Note (pdf)
Revised December 2023 2024-01-05
605a Instructions Other Progress Note (pdf)
Revised December 2020 2020-12-23
605b Other Progress Note (pdf)
Revised December 2020 2020-12-23
605c Other Progress Note - Form Fill 12-01-2020 (pdf)
Revised December 2020 2021-01-28
700 Section 7 Detail 01-15-19 (pdf)
2019-02-11
701a Instructions Discharge Summary (pdf)
Revised October 2021 2021-11-03
701b Discharge Summary - Hard Copy (pdf)
Revised October 2021 2021-11-03
701c Discharge Summary - Form Fill (pdf)
Revised October 2021 2021-11-03
703 Placement - SanWITS Discharge Profile 01-14-19 (pdf)
2019-02-11
704a Instruction Client Discharge Plan (pdf)
Revised October 2021 2021-11-03
704b Client Discharge Plan - Hard Copy (pdf)
Revised October 2021 2021-11-03
704c Client Discharge Plan - Form Fill (pdf)
Revised October 2021 2021-11-03
800 Section 8 Detail 01-15-19 (pdf)
2019-02-11
801a Instruction Drug Test and Results Log 01-11-19 (pdf)
2019-02-11
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
805 placement Referral Source Documents (pdf)
2017-05-01
807 Placement - SanWITS Residential Authorization Printout (pdf)
2019-02-11
ADOLESCENT RSUD AUTH REQUEST FAX COVER SHEET (docx)
Revised 09/01/2022 2022-09-02
ADOLESCENT RSUD AUTH REQUEST FAX COVER SHEET (pdf)
Revised 09/01/2022 2022-09-02
ADULT RSUD AUTH REQUEST FAX COVER SHEET (docx)
Revised 09/01/2022 2022-09-02
ADULT RSUD AUTH REQUEST FAX COVER SHEET (pdf)
Revised 09/01/2022 2022-09-02
SUD Residential Authorization Request (pdf)
Revised 09/01/2022 2022-09-02
SUD Residential Authorization Request (pdf)
Revised 09/01/2022 2022-09-02

Forms

BHS Inventory Form (xlsx)
2021-06-24
DPC 203 and 204 Forms (docx)
2023-02-07
Gift Card Approval Form (xlsx)
2021-06-24
PWD Accessibility Assessment (docx)
2022-11-08
PWD Program Referral List (pdf)
Updated 9/30/2021 2022-11-08
SUD Complaint Form (docx)
2021-06-24

Communications

Info Notice – DMC-ODS Documentation Reform
Effective 1, 2024 2024-01-05
SUD Access Times FAQ and Tip Sheet (pdf)
6/30/2023 2023-07-06
Info Notice – Payment Reform CPT Crosswalk (pdf)
May 15, 2023 2023-05-31
Info Notice – Open Payments Database (pdf)
05/04/2023 2023-05-19
Out-of-Network Claims Process for Indian Health Care Providers (pdf)
Revised 04/03/2023 2023-04-11
Residential OOC Medi-Cal Tip Sheet (pdf)
Revised 03/20/2023 2023-03-23
Outpatient OOC Medi-Cal Tip Sheet (pdf)
Revised 03/20/2023 2023-03-23
OTP OOC Medi-Cal Tip Sheet (pdf)
Revised 03/20/2023 2023-03-23
BHS Info Notice-DMC Process for Out-of-County Clients (pdf)
03/22/2023 2023-03-23
DMC Flowchart for Out-of-County Clients (pdf)
03/20/2023 2023-03-23
BHS and Probation Care Coordination Directive (pdf)
Revised 02/08/2023 2023-02-16
Info Notice – Documentation Reform Implementation Update (pdf)
Revised 08/15/2022 2022-08-18
00 – Archived List – Communications (pdf)
Revised 10/06/2022 2022-10-12
CYF Memo – DMC-ODS Updated Guidance for TRC Sites (pdf)
January 18, 2019 2022-10-06
Info Notice – CalAIM Documentation Reform BHS Plan
6/14/22 2022-06-24
Info Notice – New Program Enrollment – Before Admission/After Discharge (pdf)
6/23/22 2022-06-24
ACO Tip Sheet – 42 CFR Changes (pdf)
Effective 08/14/2020 2021-06-24
01 - Compliance Bulletin #30 - Cloned Documentation - 11-1017 (pdf)
2011 10/17 Issued 2018-12-06
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)
11/23/2020 2020-11-30
DHCS Medi-Cal Rx Website and Pharmacy Portal Policy (pdf)
08/14/2020 2020-10-22
DHCS Medi-Cal Rx FAQ (pdf)
06/30/2020 2020-10-22
Info Notice - Medi-Cal Rx Prescriber and Pharmacy Provider Registration and Training (pdf)
10/21/2020 2020-10-22
QM Memo – State Fair Hearing COVID Waiver (pdf)
04/16/2020 2020-05-12
3/19/20 BHS Provider Notice #3- COVID 19- Quality Improvement Updates and Best Practices (pdf)
2020-03-20
QM Memo – DSM 5 Diagnoses in SanWITS (pdf)
Issued 01/22/2020 2020-01-27
Info Notice – BHS 2020-002 - DMC-ODS Clients with Other Health Coverage (pdf)
Issued 01/15/2020 2020-01-16
Info Notice - BHS 2020-002 Assign Insurance Benefits Form (pdf)
Revised 05/20/2019 2020-01-16
Memo – DMC-ODS Travel Time Guidelines (pdf)
Updated 10-21-19 2019-10-22
Email – SUD Providers – Requirements for Policy and Procedure Development Monitoring (pdf)
2018 02/23 Emailed 2019-10-10
QM Memo - Physical Exam Requirements (pdf)
2019 10/02 Issued 2019-10-03
QM Memo - Residential Authorization Request Timelines
2019 08/05 Issued 2019-08-12
Info Notice - DMC-ODS FY 18-19 Data Entry Requirements
06/28/2019 2019-07-18
Info Notice – Share of Cost Process (pdf)
2019 02/01 Issued 2019-02-06
Memo – Patient Advocacy Services for BHS – Record Requests (pdf)
2018 10/31 Emailed 2018-11-02
Memo – Assessed No Admit and Assess Delayed Admit 10-18 (pdf)
2018 10/19 Issued 2018-10-26
Info Notice – BHS 2018-014 Timely Admissions for Collaborative Court Participants (pdf)
2018 10/19 Issued 2018-10-26
Email - BHS 2018-014: Timely Admissions for Collaborative Court Participants (pdf)
2018 10/12 Emailed 2018-10-19
Info Notice - Process for Out-of-County Clients (pdf)
2018 07/30 Issued 2018-08-06
Info_Notice_-_Reentry_and_Drug_Courts_SUD_Treatment_Services.pdf
2018 06/13 Issued 2018-06-15
Info_Notice_-_DMC-ODS_Court_Ordered_Residential_Treatment_-_Follow-Up.pdf
2018 06/12 Issued 2018-06-12
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.pdf
2018 05/17 Issued 2018-06-06

QA Training

00 - Archived List - QA Training (pdf)
Updated 09/01/2022 2022-09-02
01 – Annual DMC-ODS Training (pdf)
08/24/2023 2023-11-17
02 – Program Integrity Webinar (pdf)
Revised April 2021 2023-08-14
03 – Beneficiary Rights Webinar (pdf)
Revised 06/04/2019 2023-08-14
04 – Substance Use Disorder PRIVACY RULES 2022
2022-02-22
05 – CalMHSA Learning Management System Instructions (pdf)
2022-07-20
06 – Program Manager Orientation (pdf)
PowerPoint Presentation - 07/21/2023 2023-07-25

Manuals

County of San Diego DMC-ODS Implementation Plan.pdf
2018-09-13
County of San Diego DMC-ODS Implentation Plan Appendix.pdf
2018-09-13
00 – Archived List - Manuals (pdf)
Updated 06/30/2021 2021-07-02
CalMHSA Clinical Documentation Manual (pdf)
Revised 06/03/2022 2022-06-10
County of San Diego DMC-ODS Intergovernmental Agreement FY 2020-2023 (pdf)
2021-06-29
DHCS AOD Certification Standards (pdf)
October 2023 2024-01-08
DHCS Adolescent SUD Best Practices Guide (pdf)
October 2020 2022-08-02
DHCS Perinatal Practice Guidelines (pdf)
2020-07-17
SABG Enclosure 2 Program Specifications (pdf)
2022-02-09
Special Terms and Conditions (pdf)
Amended 12/29/2020 2021-05-21

Toolbox

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
Group Participation List (pdf)
Updated 09/2023 2023-04-20
00 – Archived List – Toolbox (pdf)
Revised 03/08/2022 2022-03-09
ASAM 0.5 Early Intervention Flowchart (pdf)
Revised 04/24/23 2023-06-20
ASAM Level of Care Guidelines (pdf)
2018-11-08
CDC Effects of Tobacco on Mental Health and Substance Use
2022-07-21
CPT Crosswalk for DMC-ODS (xlsb)
Revised 05/15/2023 2023-05-19
CRAFFT Questionnaire (TRC Only) (pdf)
2021-07-29
DHCS Toolkit – MAT in Residential Treatment Facilities (pdf)
2020-09-21
DMC-ODS SUD Provider Operations Resource Guide (pdf)
Updated December 2020 2020-12-16
Diagnosis Determination Tool (pdf)
Revised 09/2022 2023-01-27
IHCP Referral Resource (pdf)
2023-04-21
In-custody SUD Tx Self-Referral form 10-16-18 (pdf)
2018-10-26
MAT Education
Uploaded 06/08/2021 2021-06-08
One-Pager DMC-ODS Documentation Changes (pdf)
Updated Jun 18 2018 2018-06-20
One-Pager – Care Coordination in the DMC-ODS (pdf)
September 14, 2022 2022-10-26
One-Pager – Tobacco Cessation Resources
2022-07-21
Opioid Treatment Program Guidelines (pdf)
Updated 05/14/2021 2021-05-21
Outpatient Due Date Timelines – Leap Year (pdf)
Updated 10/13/2023 2023-11-09
Outpatient Due Date Timelines – Standard Year (pdf)
Updated 10/13/2023 2023-11-09
Plan of Care
Revised December 2023 2024-01-05
Priority SDOH Codes on Problem Lists (pdf)
2022-08-02
Quick Guide - DMC-ODS Client Flow Process (pdf)
2018-09-10
Quick Guide - Same Day Billing Matrix (pdf)
Updated Jun 19 2018 2018-06-22
Quick Guide – Care Coordination Activities (pdf)
September 2022 2022-10-26
Quick Guide – DSM5-ICD10 Diagnosis Guide (pdf)
Updated 10/20/22 2022-11-08
Quick Guide – Minimum Quality Drug Treatment Standards for DMC/SABG (pdf)
2022-10-26
Quick Guide – Residential Services (pdf)
Updated 10/27/2022 2023-02-14
Quick Guide – SUD Residential Clinical Documentation and Authorization (pdf)
Revised September 2022 2022-10-26
RS Enrollment in a Different Program (pdf)
09/09/2022 2022-09-14
RS Enrollment with No Prior Enrollment (pdf)
09/09/2022 2022-09-14
RS Enrollment within the Same Program (pdf)
09/09/2022 2022-09-14
Residential Due Date Timelines – Leap Year (pdf)
Updated 10/13/2023 2023-11-09
Residential Due Date Timelines – Standard Year (pdf)
Updated 10/13/2023 2023-11-09
Residential Due Date Timelines – Standard Year Immediately Preceding Leap Year (pdf)
Updated 10/13/2023 2023-11-09
Residential Weekly Services Log Tool (pdf)
Revised 09/2022 2023-01-27
Transportation Guidelines (pdf)
03/13/2024 2024-03-14
Withdrawal Management Standards (pdf)
Revised 06/04/2020 2020-11-25

Beneficiary

DMC-ODS Beneficiary Handbook_January 2024_English (pdf)
Effective 01/01/2024 2024-02-23
DMC-ODS Beneficiary Handbook_January 2024_English_Large Font (pdf)
Effective 01/01/2024 2024-02-23
DMC-ODS Beneficiary Handbook Summary of Changes 12-1-23 (pdf)
Updated December 2023 2023-11-28
DMC-ODS Beneficiary Handbook_January 2024_Farsi_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Dari.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Farsi.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Spanish_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Tagalog_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Vietnamese_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Somali.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Chinese (Trad).pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Arabic.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Spanish.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Tagalog.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Vietnamese.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Chinese (Trad)_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Korean_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Korean.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Arabic_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Somali_Large Font.pdf
Effective 01/01/2024 2024-02-07
DMC-ODS Beneficiary Handbook_January 2024_Dari_Large Font.pdf
Effective 01/01/2024 2024-02-07
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
Brochure_-_Grievance_and_Appeal_Process_-_English.pdf
For use after Jul 1 2018 2018-06-29
00 – Archived List – Beneficiary (pdf)
February 9, 2021 2021-02-10
01 – DMC-ODS Beneficiary Packet Materials Order Form (pdf)
Revised 04/18/2023 2023-09-18
Advance Directive - Dari (pdf)
2023-05-04
Advance Directive - Farsi (pdf)
2023-05-04
Advance Directive - Korean (pdf)
2023-05-04
Advance Directive – Arabic (pdf)
2023-05-04
Advance Directive – Chinese (Traditional) (pdf)
2023-05-04
Advance Directive – English (pdf)
2023-05-04
Advance Directive – Somali (pdf)
2023-05-04
Advance Directive – Spanish (pdf)
2023-05-04
Advance Directive – Tagalog (pdf)
2023-05-04
Advance Directive – Vietnamese (pdf)
2023-05-04
Brochure – Grievance and Appeal Process 08-27-21 Chinese (pdf)
2023-11-06
Brochure – Grievance and Appeal Process 08-27-21 Korean (pdf)
2023-11-06
Brochure – Grievance and Appeal Process 08-27-21 Somali (pdf)
2023-11-06
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
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 Chinese (docx)
2023-11-06
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 Korean (docx)
2023-11-06
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Somali (docx)
2023-11-06
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 08-20-21 Chinese (docx)
2023-11-06
Form – Client Grievance or Appeal – JFS Residential 08-20-21 Korean (docx)
2023-11-06
Form – Client Grievance or Appeal – JFS Residential 08-20-21 Somali (pdf)
2023-11-06
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
Limited English Proficiency Poster – Arabic (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Chinese (Traditional)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Dari (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – English (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Farsi (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Korean (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Somali (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Spanish (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Tagalog (pdf)
Revised 04/2023 2023-05-02
Limited English Proficiency Poster – Vietnamese (pdf)
Revised 04/2023 2023-05-02
Open Payments Database Notification to Clients (pdf)
2023-05-26
Poster – Grievance and Appeal 03-06-19 Arabic (pdf)
2020-03-12
Poster – Grievance and Appeal 03-06-19 Chinese (pdf)
2023-11-06
Poster – Grievance and Appeal 03-06-19 English (pdf)
2020-03-12
Poster – Grievance and Appeal 03-06-19 Farsi (pdf)
2020-03-12
Poster – Grievance and Appeal 03-06-19 Korean (pdf)
2023-11-06
Poster – Grievance and Appeal 03-06-19 Somali (pdf)
2023-11-06
Poster – Grievance and Appeal 03-06-19 Spanish (pdf)
2020-03-12
Poster – Grievance and Appeal 03-06-19 Tagalog (pdf)
2020-03-12
Poster – Grievance and Appeal 03-06-19 Vietnamese (pdf)
2020-03-12
Poster – Grievance and Appeal English LARGE FONT 03-05-19 (pdf)
2020-03-12
Quick Guide - How To Apply for Medi-Cal (pdf)
2018-11-27
Quick Guide – DMC-ODS Services in San Diego - Arabic (pdf)
Updated 03-04-2019 2019-03-05
Quick Guide – DMC-ODS Services in San Diego - English (pdf)
Updated 03-04-2019 2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Farsi (pdf)
Updated 03-04-2019 2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Spanish (pdf)
Updated 03-04-2019 2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Tagalog (pdf)
Updated 03-04-2019 2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Vietnamese (pdf)
Updated 03-04-2019 2019-03-05

NOABD

NAR_Adverse_Benefit_Determination_Upheld_Notice_-_Chinese.docx
2023-11-13
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_FARSI.doc
- 2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_SPANISH.doc
- 2018-08-07
NOABD_Modification_Notice_-_SPANISH.doc
- 2018-08-07
NOABD_Authorization_Delay_Notice_-_ENGLISH.doc
- 2018-08-07
NOABD_Modification_Notice_-_Korean.docx
2023-11-13
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
NOABD_Your_Rights_Notice_-_Chinese.docx
2023-11-13
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_SPANISH.doc
- 2018-08-07
NOABD_Financial_Liability_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
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_Korean.docx
2023-11-13
NOABD_Payment_Denial_Notice_-_Somali.docx
2023-11-13
Notice_of_Grievance_Resolution_-_ARABIC.doc
- 2018-08-07
NOABD_Timely_Access_Notice_-_SPANISH.doc
- 2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.pdf
- 2018-08-07
NOABD_Financial_Liability_Notice_-_Chinese.docx
2023-11-13
NOABD_Your_Rights_Notice_-_TAGALOG.docx
- 2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.doc
- 2018-08-07
Notice_of_Grievance_Resolution_-_Somali.docx
2023-11-13
NOABD_Timely_Access_Notice_-_TAGALOG.docx
- 2018-08-07
NOABD_Modification_Notice_-_Somali.docx
2023-11-13
NAR_Your_Rights_State_Hearing_-_Korean.pdf
2023-11-13
Beneficiary_Non-Discrimination_Notice_-_Chinese.docx
2023-11-13
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
Notice_of_Grievance_Resolution_-_Chinese.docx
2023-11-13
NOABD_Authorization_Delay_Notice_-_TAGALOG.docx
- 2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.pdf
- 2018-08-07
NOABD_Termination_Notice_-_ARABIC.doc
- 2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_Korean.docx
2023-11-13
NAR_Your_Rights_State_Hearing_-_FARSI.pdf
- 2018-08-07
NAR_Your_Rights_State_Hearing_-_Korean.docx
2023-11-13
NOABD_Modification_Notice_-_ARABIC.doc
- 2018-08-07
Beneficiary_Non-Discrimination_Notice_-_Korean.docx
2023-11-13
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_TAGALOG.docx
- 2018-08-07
NOABD_Modification_Notice_-_Chinese.docx
2023-11-13
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
Beneficiary_Non-Discrimination_Notice_-_Korean.pdf
2023-11-13
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
NAR_Your_Rights_State_Hearing_-_Chinese.docx
2023-11-13
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_Grievance_and_Appeal_Timely_Resolution_Notice_-_Chinese.docx
2023-11-13
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.doc
- 2018-08-07
NOABD_Timely_Access_Notice_-_Somali.docx
2023-11-13
NOABD_Denial_of_Authorization_Notice_–_Korean.docx
2023-11-13
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
NOABD_Financial_Liability_Notice_-_Somali.docx
2023-11-13
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.pdf
- 2018-08-07
NOABD_Authorization_Delay_Notice_-_Somali.docx
2023-11-13
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_Korean.docx
2023-11-13
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_-_Somali.docx
2023-11-13
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_Payment_Denial_Notice_SPANISH.docx
2020-06-12
NOABD_Termination_Notice_-_VIETNAMESE.doc
- 2018-08-07
NOABD_Your_Rights_Notice_-_Somali.pdf
2023-11-13
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_Termination_Notice_-_Somali.docx
2023-11-13
NOABD_Modification_Notice_-_VIETNAMESE.doc
- 2018-08-07
NAR_Your_Rights_State_Hearing_-_Somali.pdf
2023-11-13
NOABD_Payment_Denial_Notice_-_Korean.docx
2023-11-13
NOABD_Modification_Notice_-_TAGALOG.docx
- 2018-08-07
NOABD_Payment_Denial_Notice_-_TAGALOG.docx
- 2018-08-07
NOABD_Authorization_Delay_Notice_-_Korean.docx
2023-11-13
NOABD_Your_Rights_Notice_-_Korean.pdf
2023-11-13
NOABD_Financial_Liability_Notice_-_SPANISH.doc
- 2018-08-07
NAR_Your_Rights_State_Hearing_-_Chinese.pdf
2023-11-13
NOABD_Timely_Access_Notice_-_VIETNAMESE.doc
- 2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.pdf
- 2018-08-07
NOABD_Termination_Notice_-_Korean.docx
2023-11-13
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
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_Chinese.docx
2023-11-13
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_FARSI.doc
- 2018-08-07
NOABD_Financial_Liability_Notice_-_Korean.docx
2023-11-13
NOABD_Timely_Access_Notice_-_Korean.docx
2023-11-13
NOABD_Termination_Notice_-_Chinese.docx
2023-11-13
NOABD_Your_Rights_Notice_-_TAGALOG.pdf
- 2018-08-07
NOABD_Timely_Access_Notice_-_Chinese.docx
2023-11-13
NOABD_Denial_of_Authorization_Notice_–_Somali.docx
2023-11-13
Beneficiary_Non-Discrimination_Notice_-_Chinese.pdf
2023-11-13
NOABD_Your_Rights_Notice_-_ARABIC.pdf
- 2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ARABIC.doc
- 2018-08-07
NOABD_Authorization_Delay_Notice_-_Chinese.docx
2023-11-13
NOABD_Authorization_Delay_Notice_-_ARABIC.doc
- 2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ENGLISH.doc
- 2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_Somali.docx
2023-11-13
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
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_Somali.docx
2023-11-13
NOABD_Your_Rights_Notice_-_Somali.docx
2023-11-13
Beneficiary_Non-Discrimination_Notice_-_Somali.pdf
2023-11-13
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_Your_Rights_Notice_-_Chinese.pdf
2023-11-13
Notice_of_Grievance_Resolution_-_Korean.docx
2023-11-13
NOABD_Payment_Denial_Notice_-_Chinese.docx
2023-11-13
NOABD_Your_Rights_Notice_-_Korean.docx
2023-11-13
NOABD_Termination_Notice_-_FARSI.doc
- 2018-08-07
NOABD_Denial_of_Authorization_Notice_–_Chinese.docx
2023-11-13
Notice_of_Grievance_Resolution_-_SPANISH.doc
- 2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_Somali.docx
2023-11-13
NAR_Your_Rights_State_Hearing_-_Somali.docx
2023-11-13
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
NOABD Denial of Authorization Notice – ARABIC (doc)
- 2018-08-07
NOABD Denial of Authorization Notice – ENGLISH (doc)
2020-06-12
NOABD Denial of Authorization Notice – FARSI (doc)
- 2018-08-07
NOABD Denial of Authorization Notice – SPANISH (doc)
- 2018-08-07
NOABD Denial of Authorization Notice – TAGALOG (docx)
- 2018-08-07
NOABD Denial of Authorization Notice – VIETNAMESE (doc)
- 2018-08-07
NOABD_Language_Assistance_Notice_–_ENGLISH.doc
2023-11-28
NOABD_Language_Assistance_Notice_–_ENGLISH.pdf
2023-11-28
Notice_of_Adverse_Benefit_Determination_(NOABD)_Notices (pdf)
Revised 01/08/2020 2021-04-21

UTTM

For versions of the UTTM prior to September 2018, please see the “UTTM” tab on the Organizational Provider Public Documents page.
SUD Up to the Minute – April 2024 (pdf)
2023 - 2024 2024-04-11
SUD Up to the Minute – March 2024 (pdf)
2023 - 2024 2024-03-14
SUD Up to the Minute - February 2024 (pdf)
2023 - 2024 2024-02-09
SUD Up to the Minute - January 2024 (pdf)
2023 - 2024 2024-01-17
SUD Up to the Minute - December 2023 (pdf)
2023 - 2024 2023-12-19
SUD Up to the Minute - November 2023 (pdf)
2023 - 2024 2023-11-17
SUD Up to the Minute - October 2023 (pdf)
2023 - 2024 2023-10-16
SUD Up to the Minute - September 2023 (pdf)
2023 - 2024 2023-09-18
SUD Up to the Minute - August 2023 (pdf)
2023 - 2024 2023-08-11
SUD Up to the Minute - July 2023 (pdf)
2023 - 2024 2023-07-26
FY22-23 Combined (pdf)
2023-07-26
FY21-22 Combined (pdf)
2022-09-08
FY20-21 Combined (pdf)
2022-01-07
FY19-20 Combined (pdf)
2022-01-07
FY18-19 Combined (pdf)
2022-01-07

SanWITS

Forms_-_CalOMS_Admission_S111_rev_03.24 (pdf)
Revised 03/29/2024 2024-04-01
Tip Sheet - Ambulatory Withdrawal Management Services 2024.03.14 (pdf)
Tip Sheet 2024-03-28
SanWITS Data Entry Standards rev 2024.02.12.pdf
Memo – Revised 02/12/2024 2024-02-16
SanWITS_Users_Group 2024.01.22.pdf
Presentation 01.22.24 2024-01-23
SanWITS_Users_Group 2023.07.17.pdf
Presentation 07.17.23 2024-01-08
SanWITS_Users_Group 2023.10.16.pdf
Presentation 10.16.23 2024-01-08
Contingency Management Incentive Program 2023.11.30 rev.pdf
Tip Sheet – Contingency Management Incentive Program 2023-12-07
Forms_-_CalOMS_Profile_S108A_and_S108B (pdf)
Revised 10/19/2023 2023-10-24
Forms_-_SanWITS_Contact_S109 (pdf)
Revised 10/19/2023 2023-10-24
Forms_-_SanWITS_Encounter_S113 (pdf)
Revised 10/19/2023 2023-10-24
Forms_-_SanWITS_Intake_S110 (pdf)
Revised 10/19/2023 2023-10-24
Tip_Sheet_ 3-37_OOC_Claim_Summary_Report (pdf)
Tip Sheet 2023-10-24
Tip_Sheet_3-38_OOC_Claim_Details_Report (pdf)
Tip Sheet 2023-10-24
Forms_-_CalOMS_Discharge_S703 (pdf)
Revised 10/19/2023 2023-10-24
Forms_-_CalOMS_Annual_Update_S112 (pdf)
Revised 10/19/2023 2023-10-24
Tip Sheet - 3-02 CalAIM Consolidated TUOS Claim Details Report 2023.09.21 (pdf)
2023-09-22
Tip Sheet - 3-01 CalAIM Consolidated TUOS Claim Summary Report 2023.09.21 (pdf)
2023-09-22
CalAIM Payment Reform (pdf)
SANWITS CHANGES FOR RELEASE 20.7.14 2023-06-29
SanWITS_Users_Group_April_17,_2023.pdf
Presentation 04.17.23 2023-04-24
SanWITS BHS County and Optum Staff User Form (pdf)
Revised 03/29/2023 2023-03-30
SanWITS Report Request Form (docx)
Revised 03/01/2023 2023-03-16
SanWITS User Modification Termination Form (pdf)
Revised 03/10/2023 2023-03-14
SanWITS New User Form (pdf)
Revised 03/10/2023 2023-03-14
Encounter Date Outside Program Enrollment Date Range (pdf)
Encounter Audit Findings 02/15/2023 2023-02-16
SanWITS Users Group Jan 23, 2023 (pdf)
Presentation 01/23/2023 2023-01-24
Tip Sheet NOABD Notice of Adverse Benefit Determination Notice (pdf)
Revised 10/20/2022 2022-10-27
SanWITS Users Group Oct 17, 2022 (pdf)
Presentation 2022-10-18
Tip Sheet - Early Intervention Service Program Enrollment (pdf)
Tip Sheet 09/22/2022 2022-09-22
Email –SanWITS Start and End Time No Longer Required (pdf)
Email 09/15/2022 2022-09-16
Email – SanWITS Notice – Delayed Admission Program Enrollment being Removed (pdf)
Email 09/15/2022 2022-09-16
SanWITS Users Group Jul 18, 2022 (pdf)
07/18/2022 2022-08-05
Tip Sheet: Courtesy Dosage Program Enrollment in SanWITS (pdf)
Revised 07/15/2022 2022-07-19
Tip Sheet - Before Admission After Discharge Program Enrollment (pdf)
Revised 06/22/2022 2022-06-22
SanWITS Users Group Jan 24, 2022 (pdf)
2022-05-12
SanWITS Users Group Apr 18, 2022 (pdf)
2022-05-12
Tip Sheet – Recovery Residence Tracking (pdf)
Revised 1/27/2022 2022-01-28
SanWITS - Creating Diagnosis through Diagnostic Determination Notes DDN (pdf)
Revised 01/20/2022 2022-01-20
SanWITS - Telehealth and Telephone Service Encounter Tip Sheet (pdf)
Revised 12/16/2021 2021-12-16
SanWITS Users Group Oct 18, 2021 (pdf)
Presented: 10/18/2021 2021-10-27
Tip Sheet - Document Storage (pdf)
Revised 10/21/2021 2021-10-26
SanWITS Document Storage – Approved Documents for Attachment (pdf)
Revised 10/09/2021 2021-10-26
Special Notice regarding EHR Dual Entry (msg)
Email 2021-08-04
SanWITS Usesrs Group Jul 19 2021 (msg)
Email 2021-08-04
FW Important Notice - DATAR Capacity Reporting (msg)
Email 2021-08-04
Tip Sheet - Recovery Services (pdf)
Revised 07/19/2021 2021-07-22
Tip Sheet - Additional MAT - Split Dosing (pdf)
Tip Sheet - Revised 02/03/2021 2021-02-03
Tip Sheet - SanWITS EHR Readiness (pdf)
Revised 12/11/2020 2020-12-11
Basic Computer Skills Quiz (pdf)
Revised 12/11/2020 2020-12-11
Tip Sheet: Non-BHS Contracted Client Program Enrollment / CalOMS_Reporting (pdf)
Tip sheet 2020-10-28
SanWITS Billing Enhancements 20.4.5 (pdf)
Enhancements 2020-10-08
SanWITS Screen Enhancements 20.4.5 (pdf)
Enhancements 2020-10-08
Tip Sheet – OTP Reimbursement Rates Clarification (pdf)
Revised 9/23/20 2020-09-23
Tip Sheet - DSM 5 Diagnostic Labels in SanWITS (pdf)
Revised 9/21/20 2020-09-22
Tip Sheet – Drug Court Programs Workflow (pdf)
Revised 06/24/20 2020-06-25
SanWITS Flow Chart for Encounters Released to Bill and Placed on Hold (pdf)
Created 5/27/20 2020-06-15
SanWITS Flow – Group List for Outpatient Providers (pdf)
Revised 6/11/20 2020-06-12
DHCS Application Portal User Manual (pdf)
2020-04-21
DATAR Rewrite User Manual (pdf)
2020-04-21
Tip Sheet – Services provided via Telehealth (pdf)
Created 3/20/20 2020-03-25
Tip Sheet – Changing Level of Care (pdf)
Email 2020-03-06
Tip Sheet - Steps for Disallowed Services (pdf)
Created 08/23/2019 2020-02-06
CalOMS Tx Data Dictionary April 2018 (pdf)
2019-12-11
Tip Sheet - Residential Service Claims and Payor Group Enrollment (pdf)
Updated 05/30/2019 2019-08-05
Tip Sheet - Outpatient Service Claims and Payor Group Enrollment (pdf)
Updated 05/30/2019 2019-08-05
SanWITS SSRS Tip Sheet Run Reports (pdf)
2019-06-21
Service Claims and Payor Group Enrollment New Procedure (pdf)
MIS Informational Notice 2019-05-01
SanWITS Flow for Opioid Treatment Providers
2019-02-07
CalOMS Tx Data Collection Guide Jan 2014 (pdf)
2018-09-12

Billing

Assignment of Insurance Benefits Form (pdf)
Revised 05-20-19 2019-07-22
Claim Item Hold Reasons-revised 09.20233 (pdf)
The Hold Reasons list should be used when putting claims in hold status. 2023-09-20
DHCS 100186 Instructions (pdf)
How to complete the form 2020-09-25
DHCS 100186 or Claim Submission Certification Form (pdf)
Required billing certification form when submitting claim batch 2020-09-25
DHCS 6065A Form (pdf)
Late billing Good Cause Certification 2021-01-06
DHCS 6065A Form (xlsx)
Late billing Good Cause Certification 2021-01-06
DHCS 6065B Form (pdf)
Late billing and Good Cause Certification for DRC 8 2021-01-06
DMC-ODS Billing Manual v-1.5 (pdf)
The DMC-ODS Billing Manual is a DHCS publication which outlines the processes and rules for SD/MC claims for DMC-ODS services. 2024-04-11
DSM5-ICD10 Diagnosis Quick Guide (pdf)
DSM5 and ICD-10 guide
Instructions on Completing 6065A Form
2021-01-06
Instructions on Completing 6065B Form
2021-01-06
OTP Billing SanWITS Screens 11-21-2018 (pdf)
2018-12-06
OTP Disallowance After Release to Billing (pdf)
How to handle disallowances following the release to billing. Revised 12-15-2021 2021-12-16
OTP Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
The document provides guidelines for OTP providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. 2023-12-13
OTP OOC Medi-Cal Tip Sheet (pdf)
2023-03-28
OTP: Encounter Entry for Medi-Medi Methadone Claims v. 03.2024 (pdf)
The purpose of this tip sheet is to provide guidance to OTP programs on entering Medi-Medi Methadone claims in 7-day increments in SanWITS if Medi-Cal needs to be billed for unpaid costs by the primary insurance. This tip sheet is subject to change 2024-04-01
Outpatient Disallowance After Release to Billing (pdf)
This document is a revised version of the Disallowance After Release to Billing. It contains instructions on how to handle disallowances following the release to billing. 2021-12-16
Outpatient OHC or Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
The document provides guidelines for Outpatient providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. 2023-12-13
Outpatient OOC Medi-Cal Tip Sheet (pdf)
2023-03-28
Outpatient Provider Billing SanWITS Screens (pdf)
Revised 06-14-2019 2019-06-21
PGE or Benefit Plan Review Billing Tip Sheet 11-19-2018 (pdf)
2018-12-06
Payment Recovery Form_revised 08.2023 (xlsx)
The Payment Recovery Form is used by DMC Provider to report adjustable units of service. Tab 2- Instructions. Tab 3- Summary of Changes. 2023-08-24
Residential Bed Day Billing SanWITS Screens (pdf)
Rev 05-01-2019 2019-06-10
Residential Bed Day Disallowance After Release to Billing (pdf)
How to handle disallowances following the release to billing. Revised 01/26/2022 2022-01-26
Residential Care Coordination OHC or Medicare Part C Processes in SanWITS and Printing CMS 1500 Form V. 07.2023
The document provides guidelines for Residential providers on how to process/release claims for clients who have other healthcare coverage and how to print out the claim form through SanWITS. 2023-12-13
Residential Case Management Disallowance After Release to Billing (pdf)
How to handle disallowances following the release to billing. Revised 02-07-2022 2022-02-07
Residential Case Management-Recovery Services SanWITS Screens (pdf)
Rev 05-22-2019 2019-06-10
Residential OOC Medi-Cal Tip Sheet (pdf)
2023-03-28
SUD Aid Code Master Chart (xlsx)
2023-05-05
SUD Billing Announcement: Medicare Advantage Plan Rules for OTP Providers (msg)
Email announcement regarding Medicare Advantage billing rules 2022-07-14
SUD Billing Announcement: Other Health Coverage Rules for Outpatient Providers (msg)
Email announcement regarding OHC Rules 2022-07-14
SUD Billing Announcement: Other Health Coverage Rules for Residential Providers (msg)
Email announcement regarding OHC Rules 2022-07-14
SUD Claim Errors and Guides
The purpose of this tip sheet is to give advice on how to avoid and fix both common and new billing errors. 2023-10-04

PC1000

PC 1000 Education Track Fee (pdf)
2019-08-29
PC 1000 Participant Handout (docx)
` 2019-08-29
PC 1000 Participant Status Report (pdf)
` 2019-08-29
PC 1000 Program Manual (pdf)
` 2019-08-29
PC 1000 Program Orientation Checklist (docx)
` 2019-08-29
PC 1000 Referral Form (pdf)
` 2019-08-29
PC 1000 SanWITS Education Track Flow (pdf)
2019-08-29
PC 1000 SanWITS Treatment Flow (pdf)
2019-08-29

Medical Director Info

One-Pager – Medical Director in DMC-ODS (pdf)
Revised 09/13/2023 2023-09-18
10.29.20 SUD MD Exec Summary.pdf
Uploaded 11/12/2020 2020-11-12
10.15.20 SUD MD Exec Summary.pdf
Uploaded 11/12/2020 2020-11-12
10.01.20 SUD MD Exec Summary.pdf
Uploaded 11/12/2020 2020-11-12
9.17.20 SUD MD Exec Summary.pdf
Uploaded 10/01/2020 2020-10-01
8.06.20 SUD MD Exec Summary.pdf
Uploaded 10/01/2020 2020-10-01
8.20.20 SUD MD Exec Summary.pdf
Uploaded 10/01/2020 2020-10-01
5.28.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
4.09.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
5.14.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
4.23.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
4.03.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
7.23.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
6.25.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
7.09.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
4.16.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
6.11.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
4.30.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
5.07.20_SUD_MD_Exec_Summary.pdf
Uploaded 08/13/2020 2020-08-13
One-Pager – Medical Director Training Requirements (pdf)
Revised 4/21/20 2020-04-30
QM Memo - Physical Exam Requirements (pdf)
2019-10-03

Recovery Residences

00 – Archived List – Recovery Residences (pdf)
Updated 04/11/2024 2024-04-11
2020-04-20 - COVID Invoice Reporting Guidelines (pdf)
2020-09-01
One-Pager Recovery Residences – Supplemental Funding CalAIM (pdf)
12/10/2023 2024-02-09
One-Pager Recovery Residences – Supplemental Funding Pre-CalAIM (pdf)
12/10/2023 2024-03-05

Monitoring

00 – Archived List – Monitoring (pdf)
Updated 09/13/2023 2023-09-18
Annual CME-CEU Requirement Tip Sheet (pdf)
03/07/2024 2024-03-13
Corrective Action Steps for Disallowed Services (pdf)
10/09/2020 2020-10-30
Interim Services (pdf)
Updated 03/13/2023 2023-03-14
Medication Monitoring Instructions (pdf)
06/20/2019 2019-09-09
Medication Monitoring McFloop Form (pdf)
06/19/2019 2019-09-09
Medication Monitoring Submission Form (pdf)
Updated 08/31/2023 2023-09-08
Medication Monitoring Tool (pdf)
Updated 08/31/2023 2023-09-08
PSPP Tip Sheet (pdf)
10/10/2022 2022-10-12
Reasons for Disallowance (FY23-24) (pdf)
2023-08-09
Unified SUD MRR Tool FY23-24 (pdf)
Revised 08/30/2023 2023-09-18

Training - SanWITS

SanWITS Training Tips and Resources page is available for providers and Program Managers.

Video Tutorials

Training Manuals and Resources

Contracts/Fiscal Admin Svcs

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_-_Attachment_1.xlsx
2018 01/31 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.pdf
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_-_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
DMC Budget Master Template FINAL.xlsm
2021-09-02
FY2122 Provider Rate Cap (pdf)
2021-09-02
Info Notice - DMC-ODS Twice-a-Month Invoice Process (pdf)
2018 07/02 Issued 2018-07-09
Info Notice - DMC-ODS – Total Units of Service (TUOS) Report Distribution (pdf)
2019 08/13 Issued 2019-08-14
Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process - Attachment 1 (pdf)
2018 05/17 Issued 2018-06-06
Info Notice - Rate Cap Waiver Extension (Q3) (pdf)
2018 12/18 Emailed 2018-12-20
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 - Unit Production Plan (Q4) (pdf)
2019 04/04 Emailed 2019-04-10
Info Notice - Unit Production Plan (pdf)
June 17, 2019 2019-07-24
Info Notice – Extension of DMC Billable Unit Production Plan.pdf
Dec 19, 2019 2019-12-23
Info_Notice_-_FY_17-18_DMC-ODS_Enhancement_Budget-Invoice_Process_-_Attachment_3.xlsx
2018 04/05 Issued 2018-06-06
Invoicing – DMC-ODS Residential Providers (pdf)
June 27, 2019 2019-06-28
New TUOS Tip Sheet for Invoicing – OTP (pdf)
02/22/2022 2022-04-08
New TUOS Tip Sheet for Invoicing – RES and Outpatient (pdf)
02/22/2022 2022-04-08

Serious Incident Reporting

BHS SIR FAQ and Tip Sheet (pdf)
Updated 07/24/2023 2024-02-29
BHS SIROF FAQ and Tip Sheet (pdf)
Updated 07/24/2023 2024-02-29
BHS Serious Incident Report of Findings (docx)
Updated 06/30/2023 2024-02-29
Serious Incident Report (docx)
Updated 07/24/2023 2024-02-29
Serious Incident Root Cause Analysis Worksheet (doc)
Revised 07/31/2012 2024-02-29

SmartCare

System of Care (SOC) Information and Resources

SOC Resources

SmartCare Hardware, Software and Network Requirements - March 2024 update (pdf)
03/18/2024 2024-03-18

Information Notices

2024-03-11 BHS SUD Provider Memo: Important Substance Use Disorder (SUD) Electronic Health Record (EHR) Project Status Update
03/11/2024 2024-03-13
2024-04-04 SmartCare Information Notice (pdf)
04/05/2024 2024-04-08

Town Hall PowerPoint Presentations

March 2024 Town Hall
03/18/2024 2024-03-18