Substance Use Disorder Providers

Our providers are key partners in our work at Substance Use Disorder (SUD) Services. This page is designed to help you assist clients, stay informed, and access available resources. Below are some helpful links and training information. 

Provider and Behavioral Health (BH) Board-SUD Sub Committee meetings are held on the first Wednesday of each month. The Provider meeting is from 9:45 am - 10:45 pm. The BH Board-SUD Sub Committee meeting is from 11:00 am - 12:00 pm. Please contact our office at (559) 600-6087 for the location of the next meeting. 

Provider Resources 

• CalOMS-Tx_Data-Collection-Guide_Jan-2025_V.4.pdf(PDF, 1MB)
• CalOMS-Tx-Data-Dictionary_Oct-2024.pdf(PDF, 2MB)
• Data-Compliance-Standards-V3-Jan-2025.pdf(PDF, 120KB)
• DBH-Grievance-Notice-to-the-Public-English.pdf(PDF, 160KB)
• DBH-Grievance-Notice-to-the-Public-Spanish.pdf(PDF, 160KB)
• DBH-Grievance-Notice-to-the-Public-Hmong.pdf(PDF, 139KB)
• DMC Billing Manual(PDF, 2MB)
• Billing Provider Deletion Request Form(XLSX, 5MB)
• Billing Provider Deletion Request Form - How to Guide
  (PDF, 545KB)
• Cal MHSA.org
• Clinician Consultation(PDF, 203KB)
• Cost Reference Manual(PDF, 487KB)
• Fresno County SUD Provider Manual 4-2021(PDF, 1MB)
• SmartCare-SUD-Providers-Workflow-Training.pdf(PDF, 306KB)
• MyAvatar User Guides
• Avatar MSR Instructions(PDF, 1007KB)
• Monthly Screening for Ineligible Persons Information Guide(PDF, 3MB)
• Monthly Screening for Ineligible Persons Information Guide(PDF, 3MB)
• Monthly Internal Grievance Report Template and Instructions(XLSX, 25KB)
• Ineligible Persons Screening Report Template(XLSX, 66KB)
• Managed Care Transportation Handout (PDF, 506KB)
• SUD Access Form Presentation(PDF, 3MB)
• Z 55-65 Codes(PDF, 322KB)

Mandated Forms:

•  Assessment (Jan 2021)(DOCX, 78KB)
• BQuIP
• Checklist-to-Determine-Minors-Ability-to-Consent-to-SUD-Treatment-Jan-2021.docx(DOCX, 48KB)
• Diagnosis-Document-Jul-2023.docx(DOCX, 39KB)
• Fresno_County-SUD-Annual-Provider-Training-Plan-3-13-24.pdf(PDF, 234KB)
• Fresno County SUD Annual Provider Training Plan Optional Trainings(PDF, 108KB) (Dec 2022)
• Member Handbook Acknowledgment (Jan. 2021)(DOCX, 29KB)
• Notices
  • NOABD-Denial-2025.docx(DOCX, 90KB) (DOC, 138KB)
  • NOABD-Denial-Hmong-2025.docx(DOCX, 87KB)
  • NOABD-Denial-Spanish-2025.docx(DOCX, 88KB)
  • NOABD-Delivery-System-2025.docx(DOCX, 89KB)
  • NOABD-Delivery-System-Hmong-2025.docx(DOCX, 89KB)
  • (DOC, 148KB)NOABD-Delivery-System-Spanish-2025.docx(DOCX, 88KB)
  • NOABD-Financial-Liability-2025.docx(DOCX, 97KB)
  • (DOC, 137KB)NOABD-Financial-Liability-Hmong-2025.docx(DOCX, 97KB)
  • (DOC, 144KB)NOABD-Financial-Liability-Spanish-2025.docx(DOCX, 97KB)
  • NOABD-Termination-2025.docx(DOCX, 99KB)
  • (DOC, 139KB)NOABD-Termination-Hmong-2025.docx(DOCX, 96KB)
  • (DOC, 148KB)NOABD-Termination-Spanish-2025.docx(DOCX, 95KB)
  • NOABD-Timely-Access-2025.docx(DOCX, 87KB)
  • (DOC, 138KB)NOABD-Timely-Access-Hmong-2025.docx(DOCX, 90KB)
  • (DOC, 145KB)NOABD-Timely-Access-Spanish-2025.docx(DOCX, 96KB)
  • NOABD-Your-Rights-2025.docx(DOCX, 60KB)
  • NOABD-Your-Rights-2025-Hmong.docx(DOCX, 58KB)
  • Spanish(DOC, 149KB) NOABD-Your-Rights-2025-Spanish.docx(DOCX, 57KB)
  • Non-Discrimination-Notice-2025.docx(DOCX, 34KB)
  • (DOC, 158KB)Non-Discrimination-Notice-Hmong-2025.docx(DOCX, 43KB)
  • Non-Discrimination-Notice-Spanish-2025.docx(DOCX, 41KB)
  • Notice-of-Availability-Language-Tag-Lines-2025.pdf(PDF, 1MB)
• DBH PROBLEM LIST (Sep 2022)(DOCX, 31KB)
• Residential TAR (May 2024)(DOC, 68KB)
• Telehealth Consent (Jul 2022)(DOCX, 35KB)
• Updated Assessment (Aug 2022)(DOCX, 70KB)
• Withdrawal Management Assessment (Mar 2022)(DOCX, 63KB)
• Youth SUD Screening (April 2024).docx(DOCX, 52KB)

Non-Mandated Forms:

• Admission Agreement (1-28-21)(DOCX, 43KB)
• Consent to Treatment (Jan. 2021)(DOCX, 37KB)
• Discharge Plan (Jan 2021)(DOCX, 44KB)
• Discharge Summary (Jan 2021)(DOCX, 42KB)
• Emergency Contact Form (Jan 2021)(DOCX, 39KB)
• Group Sign-In Sheet (Jan 2021)(DOCX, 38KB)
• DHCS 5103 Health Questionnaire and Initial Screening(PDF, 1017KB)
• Progress Notes
  • Progress Note (Sep 2022)(DOCX, 41KB)
  • Residential Daily Note (Sep 2022)(DOCX, 42KB)
• Referral (Jan. 2021)(DOCX, 39KB)
• Release of Information (ROI)(DOCX, 92KB)
• Screening (Jan 2021)(DOCX, 71KB)        
• Treatment Plan (Jan 2021)(DOCX, 90KB)

Drug Medi-Cal Application Packet

• DMC Application Packet(PDF, 582KB)
• DMC Application Attachment X - IRS Form W-9(PDF, 117KB)
• DMC Application Attachment XI - CA Form 590(PDF, 103KB)
• DHCS Waiver Website

Credentialing

Follow the link below to the Department of Behavioral Health Managed Care Credentialing page: 

Become a Provider

State/County Contracts

• State-County DMC-ODS Contract 21-10028 FYs 2021-2024(PDF, 15MB)
• State-County DMC-ODS Contract 18-95145 FY 2019-2021(PDF, 16MB)
• State-County DMC-ODS Contract 18-95145 FY 2019-2021 - Amendment I(PDF, 10MB)
• State-County SAPT Contract 17-94127(PDF, 3MB)
• State-County SAPT Contract 17-94127 - Amendment I(PDF, 2MB)
• State-County SAGB Contract 17-94127 - Amendment II(PDF, 4MB)

Prior State-County Contracts: 

• State-County Contract 14-90056 FY 2014-2017(PDF, 7MB)
• State-County Contract 14-90056 - Amendment I(PDF, 175KB)
• State-County Contract 14-90056 - Amendment II(PDF, 1MB)
• State-County Contract 14-90056 -Amendment III(PDF, 5MB)
• State-County Contract 14-90051 - Amendment IV(PDF, 5MB)
• State-County Contract 14-90051 - Amendment V(PDF, 4MB)
• State-County DMC Contract 17-94070 FY 2017-2020(PDF, 13MB)

State-County DMC-ODS Contract 21-10028 FYs 2021-2024 – Amendment I

• IA-21-10028-A01.pdf(PDF, 2MB)

State-County DMC-ODS Contract 21-10028 FYs 2021-2024 – Amendment II

• IA-21-10028-A02-Signed-Agreement.pdf(PDF, 2MB)

 

News and Updates

Bulletins

• 2017 -Non DMC Billing(PDF, 2MB)  Minor Consent(PDF, 265KB) Provider Invoice Submission(PDF, 3MB) DMC County of Responsibility(PDF, 132KB)  Key Staffing Standards(PDF, 220KB)

• 2016 - Bed Bug Control and Prevention(PDF, 456KB)

 

Provider Medical Review PPG

30-Certification-Requirement-Tool.pdf(PDF, 81KB)

FCSUD-Audit-Notification-Letter.pdf(PDF, 222KB)

FCSUD-Chart-Review-Tool.pdf(PDF, 554KB)

FCSUD-Close-Out-Letter.pdf(PDF, 164KB)

FCSUD-Corrective-Action-Plan.pdf(PDF, 89KB)

FCSUD-Group-Observation-Tool.pdf(PDF, 82KB)

FCSUD-NTP-Facility-Walk-Through-Tool.pdf(PDF, 120KB)

FCSUD-NTP-Med-Compliance-Chart-Review-Tool.pdf(PDF, 137KB)

FCSUD-Personnel-Tool.pdf(PDF, 151KB)

FCSUD-Provider-Staff-Information-Form.pdf(PDF, 135KB)

FCSUD-Site-Review-Cover-Letter.pdf(PDF, 165KB)

FCSUD-Walk-Through-Tool.pdf(PDF, 109KB)