Claims and Eligibility

Health Networks

Addresses, phone numbers and websites

Determining which claims process applies

Where a provider files a claim for payment determining which claims processing guidelines apply depends upon whether the member is in a health network or CalOptima Direct, as well as the type of health network. Each CalOptima health network and CalOptima Direct has its own claims processing function.

As a result, it is essential that a provider identify the member’s network affiliation prior to submitting a claim for the member. This affiliation determines where the provider will file the claim, as well as the claims processing procedural guidelines that apply. For more information, see Section H of the CalOptima Provider Manual .   

CalOptima Direct/CalOptima Community Network

General Contacts

Address:
505 City Parkway West
Orange, CA 92868

Phone Numbers:
General: 714-246-8500
Claims: 714-246-8885
Authorizations: 714-246-8686
TDD Line: 800-735-2929

Professional and Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

OneCare Connect

General Contacts

Address:
505 City Parkway West
Orange, CA 92868

Phone Numbers:
General: 714-246-8500
Claims: 714-246-8885
Authorizations: 714-246-8686
TDD Line: 800-735-2929

Professional and Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
OneCare Connect Claims
P.O. Box 11065
Orange, CA 92856
(See Section H4 of the manual for details)

AMVI Care Health Network (PHC)

General Contacts

Address:
600 City Parkway West
Suite 800
Orange, CA 92868

Phone Numbers:
General: 888-747-2684 (toll-free)
24 Hour: 888-747-2684 (toll-free)

Professional Claims

AMVI Care Health Network
1920 East 17th Street, Suite 200
Santa Ana, CA 92705

Facility Claims

AMVI Care Health Network
P.O. Box 260350
Encino, CA 91426

CHOC Health Alliance (PHC)

General Contacts

Address:
1120 W. La Veta Ave.
Suite 450
Orange, CA 92868

Phone Numbers:
General: 800-424-2462 (toll-free)
24 Hour: 800-424-2462 (toll-free)

Professional and Facility Claims

Rady’s Children’s Hospital San Diego
Attn: CHOC/CPN Claims
3020 Children’s Way, Mail Code 5144
San Diego, CA 92123

Family Choice Health Network (PHC/SRG)

General Contacts

Address:
7631 Wyoming Street
Suite 202
Westminster, CA 92863

Phone Numbers:
General: 800-611-0111 (toll-free)
24 Hour: 800-611-0111 (toll-free)

Professional and Facility Claims

Family Choice Health Network
P.O. Box 260830
Encino, CA 91426

HPN-Regal Medical Group (HMO)

General Contacts

Address:
600 City Parkway West
Suite 400
Orange, CA 92868

Phone Numbers:
General: 800-747-2362 (toll-free)
24 Hour: 800-747-2362 (toll-free)

Professional and Facility Claims

Regal Medical Group
P.O. Box 371330
Reseda, CA 91337

Kaiser Permanente (HMO)

General Contacts

Address:
411 N. Lakeview Ave.
Anaheim, CA 92804

Phone Numbers:
General: 800-464-4000 (toll-free)
24 Hour: 800-984-4400 (toll-free)

Website:
www.kp.org

Professional and Facility Claims

Kaiser Permanente
P.O. Box 7102
Pasadena, CA 91109-7102
Attn: Claims Administration

Orange County Advantage Medical Group (PHC)

General Contacts

Address:
10855 Business Center Drive
Suite C
Cypress, CA 90630-5252

Phone Numbers:
General: 844-354-3535 (toll-free)
24 Hour: 844-354-3535 (toll-free)

Website:
www.ocamg.com

Professional and Facility Claims

Orange County Advantage Medical Group
PO Box 6301
Cypress, CA 90630-0018

AltaMed Medical Group (SRG)

General Contacts

Address:
2040 Camfield Avenue
Los Angeles, CA 90040

Phone Numbers:
General: 866-880-7805
Claims: 866-880-7805
Authorizations: 888-747-2684 (toll-free)
TDD Line: 714-246-8523

Website:
www.altamed.org

Professional Claims

AltaMed Health Services
P.O. Box 261790
Encino, CA 91426

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

Arta Western Health Network (SRG)

General Contacts

Address:
1665 Scenic Ave.
Suite 100
Costa Mesa, CA 92627

Phone Numbers:
General: 800-780-8879 (toll-free)
24 Hour: 800-780-8879 (toll-free)

Professional Claims

Arta Western Health Network
3333 Michelson Drive, Suite 735
Irvine, CA 92612

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

Monarch Family HealthCare (HMO/SRG)

General Contacts

Address:
11 Technology Drive
Irvine, CA 92618

Phone Numbers:
General: 888-656-7523 (toll-free)
24 Hour: 888-656-7523 (toll-free)

Professional Claims

Monarch Family HealthCare
7 Technology Drive
Irvine, CA 92618

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

Noble Mid-Orange County (SRG)

General Contacts

Address:
10855 Business Center Drive
Suite C
Cypress, CA 90630-5252

Phone Numbers:
General: 888-880-8811 (toll-free)
24 Hour: 888-880-8811 (toll-free)

Professional Claims

Noble Mid-Orange County
P.O. Box 6301
Cypress, CA 90630-6301

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

Prospect Medical Group (HMO)

General Contacts

Address:
600 City Parkway West
Suite 800
Orange, CA 92868

Phone Numbers:
General: 800-708-3230 (toll-free)
24 Hour: 800-708-3230 (toll-free)

Professional Claims

Prospect Medical Group
1920 East 17th Street, Suite 200
Santa Ana, CA 92705

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

Talbert Medical Group (SRG)

General Contacts

Address:
1665 Scenic Ave.
Suite 100
Costa Mesa, CA 92627

Phone Numbers:
General: 800-297-6249 (toll-free)
24 Hour: 800-297-6249 (toll-free)

Professional Claims

Talbert Medical Group
P.O. Box 25074
Santa Ana, CA 92799
Attn: Claims

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

United Care Medical Group (SRG)

General Contacts

Address:
600 City Parkway West
Suite 400
Orange, CA 92868

Phone Numbers:
General: 877-225-6784 (toll-free)
24 Hour: 877-225-6784 (toll-free)

Professional Claims

United Care Medical Group
P.O. Box 370940
Reseda, CA 91337

Facility Claims

Electronic Claims:
Emdeon or Office Ally
(See Section H3 of the manual for details)

Hard Copy Claims:
CalOptima Direct Claims
P.O. Box 11037
Orange, CA 92856
(See Section H4 of the manual for details)

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

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