Announcements

Recent updates, incentives and notices

Latest information

At CalOptima Health, we believe in keeping our provider partners informed to promote a positive member experience. Check here often for valuable updates and notices to assist you in achieving better health outcomes for our members.

COVID-19 Provider Information Updates for providers on CalOptima Health’s response to COVID-19 and information about your interactions with our employees and members.

Provider Alert: Updated Facility and Medical Record Audit Criteria Go into Effect on July 1

Provider Alert: CalOptima Claims Administration Policy Remains Compliant During Public Health Emergencies

Provider Alert: California Advancing and Innovating Medi-Cal (CalAIM) – In Lieu of Services (ILOS) Survey

CalAIM Survey Strategy

Provider Alert: Medi-Cal Rx Lengthens Transition Time to Full Implementation

Provider Alert: Virtual Care Innovation Network Center for Care Innovations

Provider Alert: Medi-Cal Rx Web Portal and Training Registration Guidance

Provider Alert: Medi-Cal Carve Out Education

DHCS Medi-Cal Rx Communication Materials

Distribution of recent Medi-Cal Rx Communication Materials for managed care plans (MCPs) to share as part of the transition to Medi-Cal Rx.

DHCS Medi-Cal Rx National Council for Prescription Drug Programs (NCPDP) Standard Payer Sheet

Medi-Cal Rx Web Portal Registration & Training Update

Medi-Cal Rx Prescriber Communication

Medi-Cal Rx 90-Day Pharmacy Notice

Provider Registration and Training FAQs

DHCS Aged, Blind and Disabled Federal Poverty Level (ABD FPL) Frequently Asked Questions (FAQs) This set of FAQs are related to the ABD FPL program expansion.

CQC's Resilient Primary Care Series: Primary & Maternity Care Integration Register now to join us Thursday, October 22nd at 11:00 a.m. for CQC’s webinar on Primary and Maternity Care Integration.

Vaccination During COVID Toolkit for Providers (#DontWaitVaccinate) A toolkit containing numerous helpful resources and messaging designed to assist providers with increasing member vaccination rates.

Provider Alert: Changes to CalOptima Link Provider Portal CalOptima is required to protect the privacy and security of our member’s protected health information. Therefore, we have implemented the following changes to the CalOptima Link Provider Portal.

Provider Alert: Coronavirus Disease 2019 What should you do when you identify a CalOptima member who needs testing for Coronavirus Disease 2019 (COVID-19)?

Proposition 56 Directed Payments for Adverse Childhood Experiences Screening Services (ACEs) Review trauma-informed care services and training for providers and ancillary office staff.

CalOptima’s Health Homes Program (HHP) Overview Learn more about this program which begins on January 1, 2020.

Provider Medi-Cal enrollment requirement View Medi-Cal enrollment requirements and procedures

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
Provider Reference Contact List

Provider Directory

Find a Provider
CalOptima Health works with over 3,700 Orange County physicians, making it easy for our members to get the care they need.

Check here for our extensive list of providers, health networks, medical groups, hospitals and pharmacies.

Claims

About Claims and Eligibility
Verify member eligibility or submit a request for treatment authorization.

Provider Trainings

Trainings by Topic
View the latest model of care and other educational materials designed to help you and your staff provide care for CalOptima Health members.

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