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.

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Provider Registration for Claims Submission Form  Download PDF Icon 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.

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Provider Demographic Change Form  Download PDF Icon 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).

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

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Notification of Federal Tax ID Change Form Download PDF Icon 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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