Provider

Claims Department
Reserve Network Application
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
- 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 Newsletter
Behavioral Health Advocates
Wellness

The Holman Group Contact Information

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:

The Holman Group - Managed Behavioral Health Care

The Holman Group - Provider Manual

Treatment Referrals

Please remember that each client’s benefit plan has specific program options and limitations.

Should the provider feel that a different treatment modality such as hospitalization, residential treatment, day treatment, intensive outpatient services, psychiatric or medication evaluation is indicated for a Holman referred client, the provider MUST contact the Management Department TO REQUEST SUCH A REFERRAL.

To recommend a different course of treatment for a Holman client who has only seen you for an assessment session, contact the Care Access Department. To recommend a different course of treatment for a Holman referred client who is in ongoing treatment, contact the Care Management Department.

PLEASE NOTE: It is crucial that we are able to reach the provider at all times. Please keep the Provider Relations Department current on all telephone, pager and address information. Additionally, the Provider Relations Department must receive and have on file a copy of the providers’ current license as well as liability/malpractice insurance information. We are unable to assign cases to any provider whose license and/or liability/malpractice insurance has lapsed. Please notify the Provider Relations Department in advance of any absence, vacation or change in availability. The Provider Relations Department may be reached on weekdays from 8:00 a.m. to 5:00 p.m. (PST) at (818) 704-1444, Nationwide at (800) 321-2843.

Provider Manual Table of Contents