• Claims Department
• Clinical Forms
  • Discharge Summary
  • Request for Treatment Authorization (for MDs only)
  • Request for Treatment Authorization
  • Language Capability Attestation Form
  • Clinical Assessment
  • Client Information (optional)
  • Request and Authorization of Info Form signature
  • Grievance Complaint Form Non California Members
  • Grievance Complaint Form California Members
  • Grievance Complaint Form California Members (In Spanish)
  • Coordination of Care Form
  • Behavioral Health Access and Availability Standards
  • Behavioral Health Access and Availability Standards (in Spanish)
  • Language Assistance Program enrollee notice
• Billing Forms
  • EAP Billing
  • Insurance Billing - Commercial Only - DO NOT USE FOR MEDI-CAL OR MEDICARE
  • Insurance Billing - CMS1500 - ONLY USE FOR MEDI-CAL OR MEDICARE
  • W-9 Form
• Provider Manual
  • Provider Manual (PDF Format)
• Provider Network Application (PDF Format)
  • Physician Network Application (PDF Format)
• Diversity Program
• Personal Growth Exercises
• Provider Training
  • HIPAA Security Training
  • Provider Portal Demo
• Provider Newsletter
• Cultural Competency Training
  • Cultural Competency in Healthcare Course
  • Cultural Competency Attestation Form
  • Senior Citizens and Persons with Disabilities
• Behavioral Health Care Advisor
• Wellness

To contact us by mail, please write to:
The Holman Group
9451 Corbin Ave., Suite 100
Northridge, CA 91324

To send a secure message to any of our departments, please select a department below:

• Billing & Claims Department
• Case Management & Utilization Review
• Intake Services Department
• Provider Relations Department
• Sales and Client Services