Forms & Resources


  • Specialist Roster (updated 5/18/2017): Excel

General Forms

  • Treatment Authorization (TAR) Form (Revised 4/2014): Word (Fillable) | PDF

Claims Dispute Forms

  • Provider Dispute Resolution Request (PDRR) Form: Word | PDF
  • Provider Dispute Resolution Request (PDRR) Instructions: Word | PDF

Other Forms

  • None.

MSO Contact Information:
MSO Main Phone Number:
Claims Processing & Payment:
Member/Provider Services & Eligibility:
Language Assistance:
TDD/TTY Services for deaf, hard of hearing,
or speech impaired:
Utilization Management:
415-391-9686 ext. 8160


The following services are available for members and providers who have any Utilization Management (UM) issues, such as questions pertaining to treatment requests:
  • Staff are available during normal business hours from 8:30 AM to 5:00 PM to receive phone calls.
  • After normal business hours, members and providers can leave a message on voicemail. Calls will be returned within one business day.
  • Our staff are identified by name, title and organization name when initiating or returning calls.
  • Members who are deaf, hard of hearing, or speech impaired may call 1-800-735-2929 for TDD/TTY services.
  • Members may call 415-352-5045 for language assistance.