How to Verify Eligibility

Eligibility resources

Use these resources to verify member eligibility and benefits:

Automated Eligibility Verification System (AEVS)

Call it at 800-456-2387 (Medi-Cal only).

Point of service (POS) help desk

Call 800-541-5555 only for Medi-Cal.

EDI Eligibility/Benefit Inquiry and Response Perform eligibility (270/271) transactions in real time, based on connectivity method.

CalOptima Provider Portal Access the Provider Portal.

Other contact numbers For numbers providing eligibility information about a specific medical service, view the CalOptima Eligibility and Benefits Reference Guide.

Caloptima Eligibility and Benefits Reference Guide View the guide.

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.

您可以下載免費Adobe Reader軟件閱讀本網站上的PDF 資料。請登陸此鏈接從Adobe網站免費下載。