Claims and Eligibility
CalOptima Health providers can use these tools to verify eligibility and benefits, check on the status of a claim, or request treatment authorizations.
CalOptima Health providers can use these tools to verify eligibility and benefits, check on the status of a claim, or request treatment authorizations.
Resources, forms and trainings to give our contracted providers the information they need to deliver the highest quality service to our members.
Access our provider search tool and read frequently asked questions about our programs and processes.
Information about our Quality Improvement and Health Equity program and initiatives.
Stay informed with all the latest news and updates occurring at CalOptima Health.
Join the nearly 8,400 health care professionals offering care to Orange County’s most vulnerable residents. Register to join the CalOptima Health Community Network or the CalOptima Health Behavioral Health Network.
No-cost wellness services are provided in all threshold languages in person, by phone or in a group session. To refer a member, please complete a Health and Wellness Referral Form.
Find other resources below:
Health and wellness materials for members
Interactive self-management tools for members
Cancer screening and support information
Explore tools for providing behavioral health services to our members.
CalOptima Health has offered a long-term care (LTC) benefit for members since 1998. Learn more about our program for providing care to members entering and leaving LTC facilities.
Community-Based Adult Services
LTC and Hospice Provider Forms
CalOptima Health’s Pharmacy Management department supports each of our programs.
If you see any activity that you think is fraud or waste, we strongly encourage you to call our Compliance and Ethics Hotline at (855) 507-1805. You can also report it by using CalOptima Health’s Suspected Fraud or Abuse Referral form.
You do not have to give your name to report fraudulent activity.
Download the Suspected Fraud or Abuse form
The confidential document includes instructions on how to fill it out and where to send it.
CalOptima Health strives to ensure that our contracted providers are aware of the latest industry best practices, CalOptima Health policies and state regulations. Here you can find upcoming continuing medical education (CME), CalOptima Health Community Network (CHCN) and Lunch & Learn trainings, as well as other provider-focused events.