Provider Portal
The CalOptima Health Provider Portal is a secure online website where you have 24-hour access to verify member eligibility, check claims history, check authorization status, submit referrals and more.
The CalOptima Health Provider Portal is a secure online website where you have 24-hour access to verify member eligibility, check claims history, check authorization status, submit referrals and more.
Find resources to verify CalOptima Health member eligibility.
Automated Eligibility Verification System (AEVS)
Call 800-456-2387 (Medi-Cal only).
Point of service (POS) help desk
Call 800-541-5555 (Medi-Cal only).
Learn more about the transmission of claims data, benefit eligibility and claim status inquiry.
Forms for noncontracted providers to register with CalOptima Health for claims submission or to update their information.
If you are a contracted provider or inquiring about becoming contracted, please email the Provider Relations department at providerservicesinbox@caloptima.org or visit How to Contract with CalOptima Health.
Provider Registration for Claims Submission Form
Provider Demographic Change Form
Notification of Federal Tax ID Change Form
Returned or resubmitted claims for processing will be considered a newly submitted claim.
Find the current list of procedure codes that require prior authorization and Authorization Request Forms (ARFs).
How to admit members into contracted and noncontracted hospitals for inpatient post-stabilization services.
How to file disputes for claims payments for claims where CalOptima Health has financial responsibility.
CalOptima Health Direct and each contracted CalOptima Health health network has its own process for receiving, processing and paying claims. Providers must verify member eligibility and identify the member’s assigned health network prior to submitting a claim for the member. To ensure accurate and timely payment, providers must submit the claim according to the assigned health network’s claims processing guidelines.
For a listing of health network claims processing guidelines, including information for submitting paper and electronic claims, see Section H of the CalOptima Health Provider Manual.