Manuals, Policies and Guides

CalOptima Health provider manual  The provider manual gives CalOptima Health providers the most current information about our Medi-Cal, OneCare (HMO D-SNP) and PACE programs. As a Medi-Cal managed care plan, the information in these resources is subject to change due to regulation or legislation. The manual references provider enrollment and registration responsibilities, claims submission information, member eligibility verification, and guidelines for submitting and processing medical authorizations.

PACE resource guide  The PACE Resource Guide provides information that is important for provider office staff to conduct everyday operations. The guidelines provided in this Provider Resource Guide are not all inclusive. For more detailed information and/or to obtain applicable forms and attachments, please see CalOptima’s Provider Manual.

PPS program resources and information The Pediatric Preventive Services (PPS) program is an expansion of the Child Health and Disability Prevention (CHDP) program. The information in these resources is subject to change due to regulation or legislation.

CalOptima’s Policies and Procedures Access via the Compliance 360 website.

Orange County Referral Sources for Health Homes Program 

CalAIM Enhanced Care Management Policy Guide 

Medi-Cal In Lieu of Services (ILOS) Policy Guide 

CalOptima Medi-Cal Standards of Access to Care Provider Reference Sheet 

CalOptima OneCare Standards of Access to Care Provider Reference Sheet 

Provider Quick Reference Guide Contact List