Claims And Eligibility

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Questions




If you have questions or need assistance, call our Provider Relations Department at:

1-714-246-8600

Monday through Friday from 8 a.m. to 4 p.m. Pacific Time

  • If there are multiple CalOptima PCPs, the assignment is based on the highest number of encounters for the member, followed by the recent date of service within a 12-month period.

  • If there is no recent PCP information, or the provider is not contracted as a PCP with CalOptima, the PCP assignment will be based on member geographic location and language.

  • If there are multiple matched PCPs within the member geographic location and language, the assignment will be based on rotation of available matched PCPs.
  • Geographic location of the participating PCP’s office in relation to the member’s residence

  • Match of the member’s age and language requirements to the participating PCP availability

  • If more than one PCP meets the assignment criteria, a PCP is assigned based on a rotation to allow balanced distribution

Eligibility/Benefit Inquiry And Response (270/271)

Claim Status Inquiry And Response (276/277)

CalOptima Link

How to Reach Us

If you are a provider or other health care professional and have a question regarding the Medi-Cal, OneCare (HMO SNP), OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan), or PACE programs, please call our Provider Relations Department at 1-714-246-8600.

Provider Update Notices

CalOptima Providers to Continue Using PM160 for CHDP ClaimsPDF File Indicator Image

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