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CalOptima Health Home
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For Providers

CalOptima Health’s success is a reflection of our partnerships with local health care providers. Together, we share the goal of delivering quality care that respects the dignity, value and needs of each member.

As the largest health insurer in Orange County, CalOptima Health is proud that our members have access to a comprehensive network of providers that includes nearly 8,400 primary care providers and specialists, 600 pharmacies, 40 hospitals and 200 long-term care facilities. 

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Claims and Eligibility

CalOptima Health providers can use these tools to verify eligibility and benefits, check on the status of a claim, or request treatment authorizations.

Verify Member Eligibility

Interoperability and Electronic Data Interchange

Prior Authorization

Provider Portal

Provider Complaint Process

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Documents and Training

Resources, forms and trainings to give our contracted providers the information they need to deliver the highest quality service to our members.

Manuals, Policies and Guides

Common Forms

Clinical Practice Guidelines

Provider Training

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Provider Search and FAQs

Access our provider search tool and read frequently asked questions about our programs and processes.

Provider Search Tool

Provider FAQs

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Quality

Information about our Quality Improvement and Health Equity program and initiatives.

Program Evaluation

Workplan (Coming soon)

Activity Reports (Coming soon)

CAHPS Survey

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Newsletters and Updates

Stay informed with all the latest news and updates occurring at CalOptima Health.

Provider Newsletters

OneCare Provider Letter

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Ready to Join?

Become a CalOptima Health Provider

Join the nearly 8,400 health care professionals offering care to Orange County’s most vulnerable residents. Register to join the CalOptima Health Community Network or the CalOptima Health Behavioral Health Network.

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Health and wellness

Equity and Community Health

No-cost wellness services are provided in all threshold languages in person, by phone or in a group session. To refer a member, please complete a Health and Wellness Referral Form

Find other resources below:

Bright Steps maternity program and doula services

Health and wellness materials for members

Interactive self-management tools for members

Cancer screening and support information

 

Integrated Services

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Mindful Care

Behavioral Health

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Elder Care

Long-Term Services and Supports

CalOptima Health has offered a long-term care (LTC) benefit for members since 1998. Learn more about our program for providing care to members entering and leaving LTC facilities.

Community-Based Adult Services

Contracted LTC Facilities

LTC and Hospice Provider Forms

Multipurpose Senior Services Program (MSSP)

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MEDICATIONS

Pharmacy Services

CalOptima Health’s Pharmacy Management department supports each of our programs.

Medi-Cal Pharmacy Resources

OneCare Pharmacy Resources

Pharmacy and Therapeutics Committee Changes

Pharmacy Residency Program

Pharmacy Updates

Report Fraud or Abuse

Compliance and Ethics Hotline: 1-877-837-4417

If you see any activity that you think is fraud or waste, we strongly encourage you to call our Compliance and Ethics Hotline at 1-877-837-4417. You can also report it by using CalOptima Health’s Suspected Fraud or Abuse Referral form.

You do not have to give your name to report fraudulent activity.

Download the Suspected Fraud or Abuse form
The confidential document includes instructions on how to fill it out and where to send it.

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