Claims and Eligibility

Electronic Data Interchange (EDI)

About EDI

Electronic data interchange (EDI) is a controlled transmission of claims data between providers and CalOptima. When using EDI, it takes significantly less time for provider offices to process claim submissions. This reduces payment cycle times.

Benefits of using EDI:

  • Increases productivity without increasing staff
  • Eliminates printing claims, cost of mailing and mail supplies
  • Once set up, providers can send claims to all payers
  • Correctly entered, claims will auto-adjudicate and will not require manual work
  • EDI is the most efficient way to process claims and receive payments

Email us at ebusiness@caloptima.org for help.

Contact Us
  • Providers and other health care professionals with questions regarding Medi-Cal, OneCare Connect, OneCare or PACE can call the Provider Relations department at 714-246-8600 or email: providerservices@caloptima.org

Electronic Data Interchange (EDI)
Provider Disputes
  • Dispute Process
    Review the payment dispute process for Medi-Cal and OneCare contracted providers

Prior Authorizations

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