To request prior approval for a Medi-Cal service through Ventura County’s managed care plan, use the Gold Coast authorization form — formally the Medi-Cal Prior Authorization Treatment Request Form — available as a fillable PDF on the Provider Resources page at goldcoasthealthplan.org. Complete it with the member’s identifiers, the requesting and servicing provider details, diagnosis and procedure codes, and supporting clinical records, then submit through the provider portal, by fax, or by mail.1Gold Coast Health Plan. Provider Resources
Where to Find the Right Version
Gold Coast Health Plan (GCHP) publishes two versions of the form: one for standard Medi-Cal members and a separate one for Total Care Advantage members. Both sit on the Provider Resources page as fillable PDFs you can complete on screen, print, or upload. Pick the version that matches the member’s line of coverage before you start. Using the wrong form will slow the request down.1Gold Coast Health Plan. Provider Resources
Before you fill anything out, check GCHP’s Services Requiring Prior Authorization List. If the procedure, drug, or equipment category is not on that list, prior authorization is not needed and you can bill directly.2Gold Coast Health Plan. Medi-Cal Physician Administered Drugs
What Goes on the Form
Member and Provider Information
The top section captures the member’s full name, date of birth, and GCHP ID number. These fields match the request to the eligibility record, so a single typo can bounce the form back. On the provider side, enter the requesting provider’s National Provider Identifier (NPI), federal Tax ID, and office address, along with a contact person and phone number so the utilization management team can reach someone if a clarification is needed.
If you are referring the member out, fill in the servicing provider’s name, NPI, and address too. A blank servicing provider section is one of the most common reasons referral requests get returned.
Diagnosis and Procedure Codes
Every request needs ICD-10 diagnosis codes for the condition and CPT or HCPCS codes for the service, procedure, or equipment. Enter them at the highest level of specificity available; unspecified or truncated codes often draw a technical denial because the reviewer cannot judge medical necessity from a vague diagnosis. For physician-administered drugs, use the appropriate J-code.2Gold Coast Health Plan. Medi-Cal Physician Administered Drugs
Request Type and Service Category
Mark whether the request is an initial authorization, an extension of previously approved care, or a retrospective review for services already rendered. Then classify the service — outpatient surgery, durable medical equipment, home health, inpatient admission, and so on. GCHP routes files to different review teams based on this classification, and a mislabeled request can sit in the wrong queue before someone redirects it.
Clinical Documentation
Attach supporting records with every submission. At minimum, include recent office notes documenting the condition and the clinical reasoning for the request. Depending on the service, you may also need lab results, imaging reports, prior treatment history, or a letter of medical necessity explaining why alternatives are insufficient. GCHP’s utilization management nurses apply evidence-based criteria, so documentation that speaks directly to those criteria moves faster.3Gold Coast Health Plan. Utilization Management
The most common preventable delay is submitting without enough clinical support. If the reviewer has to request records you could have attached up front, the decision clock essentially resets when those records arrive.
How to Submit
GCHP accepts the form three ways.
- Provider Portal (fastest). Log in at myportal.goldcoasthealthplan.org, upload the completed form and attachments, and get an immediate electronic confirmation. The portal also shows real-time status for pending requests.4Gold Coast Health Plan. Provider Portal
- Fax. Medical authorization requests go to 1-855-883-1552. Pharmacy authorizations use a separate line, 1-855-481-4358. Keep the confirmation page as proof of the date and delivery.
- Mail. Gold Coast Health Plan, Clinical Operations Department, 711 East Daily Drive, Suite 106, Camarillo, CA 93010. This is the slowest channel; use it only when the portal and fax are unavailable.
Whichever route you take, confirm every page transmitted cleanly and that attachments are legible. Faxed records with cut-off margins or unreadable lab values cause the same problems as missing documents.
How Long GCHP Has to Decide
California law sets firm deadlines. Under Health and Safety Code Section 1367.01, GCHP must approve, modify, or deny a routine request within five business days of receiving all reasonably necessary information. If the member’s condition poses an imminent and serious threat to health — potential loss of life, limb, or major bodily function — the decision must come within 72 hours.5California Legislative Information. California Health and Safety Code 1367.01
Prescription drug requests have their own clock under Section 1367.241: 72 hours for nonurgent requests and 24 hours for exigent circumstances. If GCHP misses those windows, the prescription request is automatically deemed approved for the duration of the prescription, including refills.6California Legislative Information. California Health and Safety Code 1367.241
Once a decision is made, GCHP must notify the requesting provider within 24 hours. If a request is denied or modified, the member gets written notice within two business days explaining the clinical reasons and how to appeal. Retrospective review follows a longer timeline, up to 30 days from receipt of necessary information.5California Legislative Information. California Health and Safety Code 1367.01
Emergency Care
Prior authorization does not apply to emergency screening or stabilization. Under the Emergency Medical Treatment and Labor Act, a hospital must provide a medical screening examination to anyone who presents at the emergency department, and if an emergency condition exists, stabilizing treatment follows regardless of insurance status or preapproval.7Office of Inspector General. The Emergency Medical Treatment and Labor Act (EMTALA) After the emergency is addressed, a provider can seek retrospective authorization by selecting that option on the form.
If the Request Is Denied
Both providers and members have ways to challenge a denial.
Provider Reconsideration
Providers use the GCHP Provider Claim Reconsideration Form, available on the same Provider Resources page as the authorization form. Submit it with any additional clinical documentation supporting medical necessity. Mail the reconsideration to:1Gold Coast Health Plan. Provider Resources
Gold Coast Health Plan
Attn: Provider Disputes & Grievances
P.O. Box 9176
Oxnard, CA 93031
The strongest appeals bring new clinical evidence or a sharper explanation tied to the criteria a medical director applies, rather than restating the original request.
Member Grievance and State Hearing
Members can file a grievance directly with GCHP by calling Member Services at 1-888-301-1228 (TTY 711). GCHP sends an acknowledgment within five calendar days and a resolution within 30 days. For a serious health concern, the member can request an expedited review resolved within 72 hours.8Gold Coast Health Plan. Medi-Cal Member Resources
If the appeal decision is still unfavorable, the member can request a State Hearing through the California Department of Social Services at 1-800-743-8525 (TTY 1-800-952-8349) or online at cdss.ca.gov. A State Hearing is free.8Gold Coast Health Plan. Medi-Cal Member Resources