Electronic Data Interchange (EDI)

About EDI

Electronic data interchange (EDI) is a controlled transmission of claims data between providers and CalOptima. When using EDI, it takes significantly less time for provider offices to process claim submissions. This reduces payment cycle times.

Benefits of using EDI:

Increases productivity without increasing staff
Eliminates printing claims, cost of mailing and mail supplies
Once set up, providers can send claims to all payers
Correctly entered, claims will auto-adjudicate and will not require manual work
EDI is the most efficient way to process claims and receive payments

Eligibility, benefit inquiry and response 270 and 271 Review requirements.

Claim status inquiry and response 276 and 277 Review requirements.

Email us at ebusiness@caloptima.org for help.

Providers and other health care professionals with questions regarding Medi-Cal, OneCare Connect, OneCare or PACE can call the Provider Resource Line 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.

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