Manuals, Policies and Guides

NOTICE: The Provider Manual and the PACE Resource Guide provide generalized information relative to the provision of healthcare goods and services to CalOptima Members. For detailed information on requirements, please refer to the applicable CalOptima Policies and Procedures. In the event of a conflict between the contents of CalOptima’s Provider Manuals or PACE Resource Guide, and CalOptima’s Policies and Procedures, the Policies and Procedures shall govern.

CalOptima Health provider manual  The provider manual gives CalOptima Health providers the most current information about our Medi-Cal, OneCare (HMO D-SNP) and PACE programs. As a Medi-Cal managed care plan, the information in these resources is subject to change due to regulation or legislation. The manual references provider enrollment and registration responsibilities, claims submission information, member eligibility verification, and guidelines for submitting and processing medical authorizations.

PACE resource guide  The PACE Resource Guide provides information that is important for provider office staff to conduct everyday operations. The guidelines provided in this Provider Resource Guide are not all inclusive. For more detailed information and/or to obtain applicable forms and attachments, please see CalOptima’s Provider Manual.

PPS program resources and information The Pediatric Preventive Services (PPS) program is an expansion of the Child Health and Disability Prevention (CHDP) program. The information in these resources is subject to change due to regulation or legislation.

The Long-Term Care Information section of this website has additional resources specifically for long term-care and hospice providers.

Policies and procedures

In addition to the provider manual, you may also access CalOptima's online policy and procedure database, hosted by Compliance 360.

CalOptima’s Policies and Procedures Access via the Compliance 360 website.

Other resources and guides

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    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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