How to Verify Eligibility

Eligibility resources

Use these resources to verify member eligibility and benefits:

Automated Eligibility Verification System (AEVS)

Call it at 800-456-2387 (Medi-Cal only).

Point of service (POS) help desk

Call 800-541-5555 only for Medi-Cal.

EDI Eligibility/Benefit Inquiry and Response Perform eligibility (270/271) transactions in real time, based on connectivity method.

CalOptima Provider Portal Access the Provider Portal.

Other contact numbers For numbers providing eligibility information about a specific medical service, view the CalOptima Eligibility and Benefits Reference Guide.

Caloptima Eligibility and Benefits Reference Guide View the guide.

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: providerservices@caloptima.org

Electronic Data Interchange (EDI)

Eligibility/Benefit Inquiry and Response (270/271)
When to use eligibility and benefit inquiry and response
Claim Status Inquiry and Response (276/277)
When to use claim status inquiry and response

Provider Disputes

Dispute Process
Review the payment dispute process for Medi-Cal and OneCare contracted providers

Prior Authorizations

Authorization required procedure codes
The authorization required procedure codes list for medical and outpatient services should be used for services rendered.

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