Provider Claim Registration Forms

Claims Registration Process

Below you will find the tools needed for updating provider information for claim submissions to CalOptima. If you should have any questions regarding this process, contact Provider Data Management Services at 714-246-8468. Completed forms should be faxed to CalOptima at 714-954-2330.

Provider Demographic Changes form Complete this form when there is a change to a provider group or solo provider’s billing, practice or contractual notice of demographic information.

Provider Registration for Claim Submission form Complete this form when requesting claim submission access to CalOptima.

Notification of Federal Tax ID Change form Complete this form when making a change to provider’s tax ID information.

Request for Tax ID and Certification (W-9) form Must submit a new W-9 form when making change to provider’s Federal Tax ID information.

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)

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.

Materials available on this website in PDF format may require the free Adobe Reader to view. To download Adobe Reader for free from the Adobe website, click here.