Claims and Eligibility

How to Verify Eligibility

Eligibility resources

Use these resources to verify member eligibility and benefits:

CalOptima Interactive Voice Response (IVR)

Call it at 800-463-0935.

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.

Contact Us
  • 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

Electronic Data Interchange (EDI)
Provider Disputes
  • Dispute Process
    Review the payment dispute process for Medi-Cal and OneCare contracted providers

Prior Authorizations

Download the free Adobe Reader.

مطالب موجود در این وب سایت به فرمت PDF ، ممکن است برای مشاهده به Adobe Reader نیاز داشته باشند. برای دان لود کردن رایگان Adobe Reader از وب سایت Adobe ، اینجا را کلیک کنید.