CalOptima’s success is a reflection of our partnerships with local health care providers. Together, we share the goal of delivering quality care to our members.

As the largest health insurer in Orange County, CalOptima is proud our members have access to a comprehensive network of providers that includes more than 7,000 doctors, 500 pharmacies, 30 community health centers, and a majority of the hospitals and long-term care facilities in the area.

Every one of our partnerships with local health care providers is important to us. Our goal is to make it easier for providers to do the best possible job of serving our members.

Providers and other health care professionals who have questions regarding Medi-Cal, OneCare Connect, OneCare or PACE can call our Provider Relations Department at 1-714-246-8600.

Network Expansion

As our community’s need for cost-effective quality health care services expands, so does the need to enhance our delivery system by increasing the number and type of providers available to members. See the links below for more information.
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Provider Trainings

CalOptima works together with its partners to ensure the latest model of care and other educational materials are available to our provider community. In this section you will find provider trainings and resources on a number of topics.

Provider Trainings
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Links and Resources

Quick Links
Provider FAQs

Updates and Events

Important Updates
Effective January 1, 2016, MedImpact is CalOptima’s new pharmacy benefit manager. CalOptima contracts with MedImpact to administer our pharmacy program. MedImpact provides claims processing, pharmacy network management, prior authorization processing, and drug utilization management services. Beginning 1/1/16, providers must use a new Prior Authorization (PA) form.
CalOptima is ready to accept ICD-10 codes for claims with D/O/S on or after 10/1/15. For more information, view our ICD-10 FAQs.
Events and Workshops
Provider Communications
Prior Auth Information
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Report Fraud or Abuse

You Can Report Fraud or Abuse. If you see any activity that you think is fraudulent or wasteful, we strongly encourage you to call our Compliance and Ethics Hotline at 1-877-837-4417 or report the activity using the Suspected Fraud or Abuse Referral Form. You do not have to give your name to report fraud activity.
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