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.

SUDPOH

SUDPOH Appendix G.2 - Serious Incident Report of Findings (SIROF) 12/15/18 (doc)
2018-12-20
Appendix F.4 – Payment Recovery Form (Void-Disallowance) (xlsx)
Updated 06-15-2019 2019-07-22
Appendix F.5 – Claims Adjustment Form (Valid Denial) (xlsx)
Revised 07-01-19 2019-07-22
Appendix F.6 – BHS (xlsx)
2019-07-22
Appendix F.7 – DPC 2013 Fillable (pdf)
2019-07-22
Appendix F.8 – DPC 203 Mobile Devices (2019) (xls)
2019-07-22
SUDPOH Appendix D.4 - Group Counseling Sign In Sheet Form Fill 06-06-19 (pdf)
Updated 06-06-19 2019-06-11
SUDPOH Appendix E.4 - Program Accessibility Assessment 4-2018 (docx)
2018-07-11
SUDPOH Appendix F.2 - Gift Card Approval Form (xlsx)
2017-10-16
SUDPOH Appendix F.9 - DPC203 Mobile Devices SUPPLEMENTAL 2017 (xls)
2018-08-22
SUDPOH Appendix G.1 - Root Cause Analysis Worksheet - Rev 7/31/12 (doc)
2018-07-11
SUDPOH Appendix G.3 - Serious Incident Report (SIR) 12/15/18 (doc)
2018-12-20
SUDPOH Appendix G.5 – SUD Complaint Report Form 8-30-17 (docx)
2018-08-22
SUDPOH revised 07-11-19 (pdf)
2019-09-11
Summary of Changes rv 7-11-19 (pdf)
2019-09-13

SUDURM

00 – SUD Uniform Record Manual 07-01-19 (pdf)
2019-09-03
01 – Uniform Record Manual 07-01-19 (pdf)
Revised July 2019 2019-07-31
02 - Client File Order 07-01-19 (pdf)
2019-07-24
03 - Section 1 Detail 01-14-19 (pdf)
2019-02-11
101a Instruction Client Tracking 07-01-19 (pdf)
2019-07-26
101b Client Tracking 07-01-19 (pdf)
2019-07-26
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 ASAM Screening 01-07-19 (pdf)
2019-02-11
104b-2 Brief ASAM Screening Tool Hard Copy 01-07-19 (pdf)
2019-02-11
104b-3 Brief ASAM Screening Tool Form Fill 01-07-19 (pdf)
2019-02-11
104c-1 Instructions Adult Initial Level of Care Assessment 07-01-19 (pdf)
2019-07-26
104c-2 Adult Initial LOC Assessment Hard Copy 07-01-19 (pdf)
2019-07-26
104c-3 Adult Initial LOC Assessment Form Fill 07-01-19 (pdf)
2019-07-26
104d-1 Instructions Adolescent Initial LOC Assessment 07-01-19 (pdf)
2019-07-26
104d-2 Adolescent Initial LOC Assessment Hard Copy 07-01-19 (pdf)
2019-07-26
104d-3 Adolescent Initial LOC Assessment Form Fill 07-01-19 (pdf)
2019-07-26
104e-1 Instructions Parent Guardian Initial Level of Care Assessment 07-01-19 (pdf)
2019-07-26
104e-2 Parent Guardian Initial LOC Assessment Form Fill 07-01-19 (pdf)
2019-07-26
104e-2 Parent Guardian Initial LOC Assessment Hard Copy 07-01-19 (pdf)
2019-07-26
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 Info and MC SOC 1-30-19 (pdf)
2019-02-11
107b Financial Responsibility Information and MC SOC 1-30-19 (pdf)
2019-02-11
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 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
209a Instruction Acknowledgement of DMC-ODS Handbook Practice Guidelines and Provider Directory 03-07-19 (pdf)
2019-03-21
209b Acknowledgement of DMC-ODS Beneficiary Handbook Practice Guidelines and Provider Directory 03-07-19 (pdf)
2019-03-21
210a Instructions SUD Program Admission Checklist 6-27-18 (pdf)
2018-07-06
210b SUD Program Admission Checklist 1-3-19 (pdf)
2019-02-11
300 Section 3 Detail 7-3-18 (pdf)
2018-07-06
301a Instruction Justification for Continuing Services 07-01-19 (pdf)
2019-07-26
301c Justification for Continuing Services Form Fill 07-01-19 (pdf)
2019-09-03
301c Justification for Continuing Services Hard Copy 07-01-19 (pdf)
2019-07-26
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
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-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
306a Instructions ASAM Level of Care Recommendation 01-04-19 (pdf)
2019-02-11
306b ASAM LOC Recommendation 6-11-18 (pdf)
2018-07-06
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
308a Instructions Diagnosis Determination Note 01-11-19 (pdf)
2019-02-11
308b Dx Determination Note Hard Copy 07-01-19 (pdf)
2019-07-26
308c Dx Determination Note Form Fill 07-01-19 (pdf)
2019-09-03
400 Section 4 Detail 01-14-19 (pdf)
2019-02-11
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 01-11-19 (pdf)
2019-02-11
404b TB screening form 4-12-17 (pdf)
2017-05-01
406 Physician Direction Form 4-12-17 (pdf)
2017-05-01
406a Instruction Physician Direction form 01-09-19 (pdf)
2019-02-11
407 MD Recomendation to client 4-12-17 (pdf)
2017-05-01
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 Initial Treatment Plan 07-01-19 (pdf)
2019-07-26
501b Initial Treatment Plan 07-01-19 (pdf)
2019-07-26
502a Instructions Updated Treatment Plan 01-11-19 (pdf)
2019-07-26
502b Updated Treatment Plan 07-01-19 (pdf)
2019-07-26
503a Instructions Treatment Plan Addendum 01-11-19 (pdf)
2019-02-11
503b Treatment Plan Addendum 6-11-18 (pdf)
2018-07-09
504a Instructions Recovery Plan (pdf)
2019-03-18
504b Recovery Plan Worksheet (pdf)
2019-03-18
505a Instructions Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
505b Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
506a Instructions WM TX Plan for DMC-ODS (pdf)
2019-03-18
506b WM Tx Plan for DMC-ODS (pdf)
2019-03-18
600 Section 6 Detail 01-15-19 (pdf)
2019-02-11
601a Instructions SUD Treatment Progress Note 07-01-19 (pdf)
2019-07-26
601b SUD Treatment Progress Note - Hard Copy 07-01-19 (pdf)
2019-07-24
601c SUD Treatment Progress Note - Form Fill 07-01-19 (pdf)
2019-07-24
602a-1 Instructions for Residential Weekly Progress Note - Narrative 01-24-19 (pdf)
2019-02-11
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 01-24-19 (pdf)
2019-02-11
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
604a Instructions Outpatient Group Progress Note 07-01-19 (pdf)
2019-10-10
604b Outpatient Group Progress Note Hard Copy 07-01-19 (pdf)
2019-07-26
604c Outpatient Group Progress Note Form Fill 07-01-19 (pdf)
2019-07-26
700 Section 7 Detail 01-15-19 (pdf)
2019-02-11
701a Instructions Discharge Summary 07-01-19 (pdf)
2019-07-26
701b Discharge Summary - Hard Copy 07-09-2019 (pdf)
2019-07-26
701c Discharge Summary - Form Fill 07-09-2019 (pdf)
2019-07-26
703 Placement - SanWITS Discharge Profile 01-14-19 (pdf)
2019-02-11
704a Instruction Client Discharge Plan 4-12-17 (pdf)
2017-05-01
704b Client Discharge Plan 07-01-19 (pdf)
2019-07-26
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
806a FAX COVER SHEET FOR RSUD AUTH (docx)
2018-08-02
806b FAX COVER SHEET FOR RSUD AUTH Form Fill (pdf)
2018-08-02
807 Placement - SanWITS Residential Authorization Printout (pdf)
2019-02-11

Communications

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 - Medical Record Reviews (pdf)
2019 10/07 Issues 2019-10-07
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 - FY 19-20 DMC-ODS Interim Rates (pdf)
2019 07/01 Issued 2019-08-14
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
Email – SUD Providers – Requirements for Policy and Procedure Development Monitoring (pdf)
2018 02/23 Emailed 2019-10-10
Info Notice - Amended Process for Out-of-County Clients (pdf)
July 1, 2019 2019-07-24
Info Notice - Amended Process for Out-of-County Clients – OTP Out of County MCal Tip Sheet (pdf)
July 1, 2019 2019-07-24
Info Notice - Amended Process for Out-of-County Clients – Out-of-County Flowchart (pdf)
July 1, 2019 2019-07-24
Info Notice - Amended Process for Out-of-County Clients – Outpatient Out of County MCal Tip Sheet (pdf)
July 1, 2019 2019-07-24
Info Notice - Amended Process for Out-of-County Clients – Residential BD Out of County MCal Tip Sheet (pdf)
July 1, 2019 2019-07-24
Info Notice - Amended Process for Out-of-County Clients – Residential CM Out of County MCal Tip Sheet (pdf)
July 1, 2019 2019-07-24
Info Notice - DMC-ODS FY 18-19 Data Entry Requirements
06/28/2019 2019-07-18
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 - Process for Out-of-County Clients (pdf)
2018 07/30 Issued 2018-08-06
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 - Recovery Residence Tracking (pdf)
June 28, 2019 2019-07-24
Info Notice - Timely Access to Services (pdf)
2018 07/31 Issued 2018-08-06
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 – BHS 2018-014 Timely Admissions for Collaborative Court Participants (pdf)
2018 10/19 Issued 2018-10-26
Info Notice – Share of Cost Process (pdf)
2019 02/01 Issued 2019-02-06
Initial Billing Compliance Reviews (pdf)
2018-09-26
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 – DMC-ODS Travel Time Guidelines (pdf)
Updated 10-21-19 2019-10-22
Memo – Patient Advocacy Services for BHS – Record Requests (pdf)
2018 10/31 Emailed 2018-11-02
Memo – SanWITS DMC-ODS Data Entry Standards (pdf)
2019 03/29 Emailed 2019-04-02
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

QM Training

01 – DHCS DMC Certification PAVE (pdf)
2019-06-20
02 – DHCS DMC Certification PAVE Video Transcript (pdf)
2019-06-20
03 – DHCS DMC Certification PAVE Support Resources Table (pdf)
2019-06-20
09 - Example 3.1 ASAM LOC Recommendation (pdf)
2018-08-30
10 - Example 3.1 Initial LOC Assessment (pdf)
2018-08-30
11 – Example 3.5 Initial LOC Assessment (pdf)
2018-08-30
12 – Example 3.5 Initial Treatment Plan (pdf)
2018-08-30
13 - Example Residential Weekly Progress Note Narrative and Services (pdf)
2018-10-26
14 – Example Residential or WM Daily Progress Note (pdf)
2018-10-26
15 - Example SUD Treatment Progress Note - Case Management (pdf)
2018-10-26
16 - QM Memo - SUD Providers - Beneficary Rights Webinar (pdf)
Revised 06/04/2019 2019-06-05
17 – Module 1: Introduction to DMC-ODS (pdf)
2019-01-15
18 – Module 2: Medical Necessity (pdf)
Rev 6-11-19 2019-06-13
19 – Module 3: Treatment Planning for Substance Use Disorders (pdf)
Rev 6-7-19 2019-06-13
20 – Module 4: SUD Services in Residential (pdf)
Updated 04-25-19 2019-04-26
21 – Module 5: SUD Services in Outpatient (pdf)
2019-01-15
22 - Module 6: Progress Notes Documentation (pdf)
Updated 06-18-2019 2019-06-20
23 – Module 7: Discharge (pdf)
Revised 08-28-19 2019-09-03
24 - Module 8: Recovery Services (pdf)
2019-03-12
25 – Quality Assurance Review Webinar (pdf)
Revised 07-03-19 2019-07-08

Manuals

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 Interim Rate Caps.pdf
County of San Diego DMC-ODS Intergovernmental Agreement Contract 2019
Updated 2019 2019-05-13
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

ASAM Training Q and A (docx)
2017-11-30
ASAM Training Tracking Log 01-29-18.xlsx
2018-02-09
CIBHS ASAM A Criteria Webinar (pdf)
Rev 5-30-19 2019-06-13
CIBHS ASAM B Criteria Webinar (pdf)
Rev 5-30-19 2019-06-13
Change Companies e-trainings.pdf
2018-02-09

Toolbox

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
2019-2020 Reasons for Disallowance (pdf)
2019-08-05
ASAM Level of Care Guidelines (pdf)
2018-11-08
DMC-ODS Medication Monitoring Instructions (pdf)
06/20/2019 2019-09-09
DMC-ODS Medication Monitoring McFloop Form (pdf)
06/19/2019 2019-09-09
DMC-ODS Medication Monitoring Submission Fillable Form (pdf)
06/18/2019 2019-09-09
DMC-ODS Medication Monitoring Tool (pdf)
06-19-2019 2019-09-09
DMC-ODS SUD Provider Operations Resource Guide (pdf)
2019-01-31
In-custody SUD Tx Self-Referral form 10-16-18 (pdf)
2018-10-26
Invoicing – DMC-ODS Residential Providers (pdf)
June 27, 2019 2019-06-28
One-Pager DMC-ODS Documentation Changes (pdf)
Updated Jun 18 2018 2018-06-20
Outpatient Due Date Timelines - Leap Year (pdf)
2019-11-07
Outpatient Due Date Timelines - Standard Year (pdf)
2019-11-07
QAR - Quality Assurance Review Changes FY 19-20 (pdf)
Updated 5-31-19 2019-06-21
QAR - Self Review Tip Sheet (pdf)
2019-07-08
QAR – Tool for Self-Review (pdf)
Revised 07-24-19 2019-07-31
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 - 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
Quick Guide – Case Management Activities (pdf)
2019-10-10
Recovery Residences – Supplemental Funding Guidelines (pdf)
Updated July 16, 2019 2019-07-18
Residential Due Date Timelines - Leap Year (pdf)
2019-11-07
Residential Due Date Timelines - Standard Year (pdf)
2019-11-07
Transportation Guidelines (pdf)
Updated 10-25-19 2019-10-28
Withdrawal Management Standards (pdf)
Updated March 7, 2019 2019-03-08

Beneficiary

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
Poster - Grievance and Appeal - English.pdf
For use after Jul 1 2018 2018-06-29
Limited English Proficiency Poster Vietnamese 07-10-18.pdf
2019-01-28
Limited English Proficiency Poster Tagalog 07-10-18 .pdf
2019-01-28
Limited English Proficiency Poster Spanish 07-10-18.pdf
2019-01-28
Limited English Proficiency Poster Farsi 07-10-18.pdf
2019-01-28
Limited English Proficiency Poster English 07-10-18.pdf
2019-01-28
Limited English Proficiency Poster Arabic 07-10-18.pdf
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 Handbook Large Print – English (pdf)
2019-02-14
DMC-ODS Beneficiary Handbook – Arabic (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Arabic LG Print (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – English (pdf)
2019-02-14
DMC-ODS Beneficiary Handbook – Farsi (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Farsi LG Print (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Spanish (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Spanish LG Print (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Tagalog (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Tagalog LG Print (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Vietnamese (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Handbook – Vietnamese LG Print (pdf)
Updated 12-07-2018 2019-03-20
DMC-ODS Beneficiary Packet Materials Order Form 05-09-19 (pdf)
2019-05-13
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
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 - 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.
SUD Up to the Minute - January 2019 (pdf)
2019-01-10
SUD Up to the Minute - October 2019 (pdf)
2019-10-10
SUD Up to the Minute - April 2019 (pdf)
2019-04-12
SUD Up to the Minute - December 2018 (pdf)
2018-12-13
SUD Up to the Minute - March 2019 (pdf)
2019-03-20
SUD Up to the Minute - May 2019 (pdf)
2019-05-13
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)
2018-09-20
SUD Up to the Minute 2018 Year-End Summary (pdf)
2019-01-02
SUD Up to the Minute – August 2019 (pdf)
2019-08-21
SUD Up to the Minute – February 2019 (pdf)
2019-02-15
SUD Up to the Minute – July 2019 (pdf)
2019-07-31
SUD Up to the Minute – June 2019 (pdf)
2019-06-13
SUD Up to the Minute – November 2019 (pdf)
2019-11-13
SUD Up to the Minute – September 2019 (pdf)
2019-09-17

SanWITS

Forms - CalOMS Admission.pdf
- 2019-02-08
Forms - CalOMS Annual Update.pdf
- 2019-02-08
Forms - CalOMS Discharge.pdf
- 2019-02-08
Forms - CalOMS Profile.pdf
- 2019-02-08
Forms - SanWITS Contact.pdf
- 2019-02-08
Forms - SanWITS Encounter.pdf
- 2019-02-08
Forms - SanWITS Intake.pdf
- 2019-02-08
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
How to – Configure a Digital ID for Signing (pdf)
2019-07-08
Outpatient Encounters and Group Modules Training Manual (docx)
2019-10-25
Residential Bed Management Encounters and Group Modules Training Manual (docx)
2019-10-25
SanWITS - Access to Service Data Collection Tip-Sheet (pdf)
Updated 6/27/2019 2019-07-01
SanWITS Basic Training Manual (docx)
2019-10-25
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)
2019-02-07
SanWITS New User Form (pdf)
Revised 07-01-19 2019-07-08
SanWITS Report Request Form (pdf)
2019-06-04
SanWITS SSRS Tip Sheet Run Reports (pdf)
2019-06-21
SanWITS Tip Sheet - NOABD (Notice of Adverse Benefit Determination) (pdf)
Created 08/06/2019 2019-10-25
SanWITS Tip Sheet - Outpatient Service Claims and Payor Group Enrollment (pdf)
Updated 05/30/2019 2019-08-05
SanWITS Tip Sheet - Program Enrollment for NON BHS Contracted Clients (pdf)
Revised 08/12/19 2019-08-16
SanWITS Tip Sheet - Residential Service Claims and Payor Group Enrollment (pdf)
Updated 05/30/2019 2019-08-05
SanWITS User Modification or Termination (pdf)
2019-07-08
Service Claims and Payor Group Enrollment New Procedure (pdf)
MIS Informational Notice 2019-05-01
Webinar – TUOS Announcement New Reports for Invoicing (pdf)
2019-05-29
Webinar – TUOS Group Session ID (pdf)
2019-05-29
Webinar – TUOS Summary and Detail Invoicing Demo (pdf)
2019-05-29

Billing

BHS Drug Medi-Cal Organizational Providers Billing Manual.pdf
Updated Jun 18 2018 2018-06-21
Assignment of Insurance Benefits Form (pdf)
Revised 05-20-19 2019-07-22
Claims Adjustment Form (Valid Denial) (xlsx)
Revised 07-01-19 2019-07-08
DHCS Drug Medi-Cal Billing Manual (pdf)
Updated April 2019 2019-04-29
Disallowance After Release to Billing OTP (pdf)
2019-10-28
Disallowance After Release to Billing Outpatient (pdf)
2019-09-26
Disallowance After Release to Billing Residential BD (pdf)
2019-09-26
Disallowance After Release to Billing Residential Case Mgt (pdf)
2019-09-26
OTP Billing SanWITS Screens 11-21-2018 (pdf)
2018-12-06
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 (Void-Disallowance) (xlsx)
Revised 06-15-2019 2019-06-21
Residential Bed Day Billing SanWITS Screens (pdf)
Rev 05-01-2019 2019-06-10
Residential Case Management-Recovery Services SanWITS Screens (pdf)
Rev 05-22-2019 2019-06-10

PC1000

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

Medical Director Info

One-Pager - Medical Director in DMC-ODS (pdf)
2018-07-05
QM Memo - Physical Exam Requirements (pdf)
2019-10-03