For Providers
Provider resource library.
Compliance training, clinical criteria, IPA manuals, health-plan references, and regulatory resources for the MSO Inc. network. All documents open in a new tab.
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Section 1 · Audit-critical
Annual Compliance Training
Attestation pinned at top. Each item shows its last-updated date.
- Attestation for 2026 Annual Compliance Training ProgramLast updated: Nov 2025· Pinned — required attestation
- MSO Compliance Plan 2026Last updated: Nov 2025
- Code of Business Conduct and Ethics — Rev 12Last updated: Nov 2025
- Compliance / Code of Conduct Charter — Rev 14Last updated: Nov 2025
- FWA Compliance — Sections 1–8, Rev 20Last updated: Nov 2025
- FWA Executive Summary 2026Last updated: Nov 2025
- HIPAA Executive SummaryLast updated: Nov 2025
- HIPAA Privacy Training — Sections 1–12, Rev 20Last updated: Nov 2025
- MSO Policy No. MSO-03Last updated: Nov 2025
- Notice of Non-Discrimination or Financial Incentives 2026Last updated: Nov 2025
- Staff Confidentiality Statement 2026Last updated: Nov 2025
Cultural & Linguistic (C&L)
- Policy No. CLAS-6Last updated: Nov 2025
- Guidelines for Gender-Inclusive Sensitive LanguageLast updated: Nov 2025
- HICE C&L Services Provider ToolkitLast updated: Nov 2025
- Language Self-Assessment FormLast updated: Nov 2025
- Language Proficiency Assessment ResourcesLast updated: Nov 2025
- Cultural Linguistic Plan (P&P CLAS-6)Last updated: Nov 2025
Section 2 · Audit-critical
Clinical Criteria & Practice Guidelines
Criteria hierarchy
- CMS National Coverage Determination (NCD)Last updated: Nov 2025
- Local Coverage Determination (LCD)Last updated: Nov 2025
- Local Coverage Articles (LCA)Last updated: Nov 2025
- CMS Internet-Only Manuals (IOMs)Last updated: Nov 2025
- Medicare Benefit Policy Manual Ch. 15Last updated: Nov 2025
- DHCS Medi-Cal GuidelinesLast updated: Nov 2025
Health plan clinical policies (by plan / line of business)
- Alignment Health PlanNo dedicated CPG page (MCG medical-necessity guidelines only)
- Anthem Blue Cross / Elevance (CA)
- AstivaNo dedicated CPG page (UM criteria only)
- Blue Shield CA / Promise
- Blue Cross Blue Shield of Texas
- Central Health / Molina
- Champion HealthNo dedicated CPG page (portal-gated)
- Clever Care Health PlanSee Section 4 — Health Plan Resources
- Health Net of California (Centene)
- Molina Health Plan
- SCAN Health Plan
- Verda Healthcare
- Wellcare by Health Net (CA)
- Wellpoint (TX)
General CPG references
Section 3
IPA-Specific Provider Manuals
Section 4
Health Plan Resources
Clever Care Health Plan
Clever Care CPGs
Blue Shield CA Promise
Section 6
Government & Regulatory
- Medi-Cal 101 – Member Booklet (CA Health & Wellness)
- FWA for Health Care Providers (OIG / HHS)
- HICE FWA Training
- HICE General Compliance
- DHCS – Welcome New Medi-Cal Providers
- DHCS – Outreach & Education
- DHCS – Medi-Cal Subscription Services (MCSS)
- DHCS – Provider Portal
- Comprehensive Perinatal Services Program (CPSP)
- Advance Health Care Directive Form (CA OAG)
- Multicultural Competency in Wellness (National Wellness Institute)
Section 7
Provider Operational Manuals
For services that are carved out and/or the health plan's responsibility (i.e., hospice, home health, transportation, behavioral health, etc.), please refer to the health plan's Provider Manual for guidelines and coordination of services.
Questions? Call UM at 1-800-551-1319 · Monday–Friday 8:00 AM–5:00 PM.
