Claims and Eligibility

Provider Claim Registration Forms

Claims Registration Process

Below are links to the forms needed for registering with CalOptima Health as a non-contracted provider and/or updating provider information for non-contracted providers for claim submissions to CalOptima Health.

If you have questions, contact Provider Data Management Services at 714-246-8468. Completed forms and a copy of returned claims should be faxed to CalOptima Health at 714-954-2330 or emailed to .

If you are a contracted provider or inquiring about becoming contracted, please email the Provider Relations department at or visit How to Contract with CalOptima Health.

Provider Registration for Claims Submission Form   Complete this form if you received a returned claim from CalOptima Health or need to submit claims for payment consideration. Include a copy of the returned claim, if applicable.

Provider Demographic Change Form   Complete this form if you are a non-contracted provider with a returned claim due to a discrepancy in the provider information (service location, remit address or tax ID).

W9 Form  A completed W9 is required when submitting a Provider Registration for Claim Submission Form or a Provider Demographic Change Form.

Notification of Federal Tax ID Change Form  This form is required when submitting a tax ID change for a group and/or facility.

Returned or resubmitted claim(s) for processing will be considered a newly submitted claim.

Contact Us
  • Providers and other health care professionals with questions regarding Medi-Cal, OneCare Connect, OneCare or PACE can call the Provider Resource Line at 714-246-8600 or email:

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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