CalOptima Health provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.caloptima.org/en/for-providers/provider-resources/manuals-policies-and-guides |
|---|---|
| Payer contact reference | 1-714-246-8600714-246-8600 remains the current Claims and Provider Resource Line and is identified in the manual for complex claims. The EDI page separately lists a claim-status contact; do not replace a valid provider-support number merely because a narrower route exists. |
| Claims payer ID | The September 2026 manual H3 identifies Office Ally CALOP for professional CMS-1500 and facility UB claims, Change Healthcare 99250 for LTC/facility claims, and COLTC for long-term-care 25-1 billing. Apply only where CalOptima is financially responsible; delegated networks and OneCare professional claims can route elsewhere. |
| Eligibility payer ID | CalOptima’s public EDI page documents 270/271 and 276/277 onboarding but does not establish CALOP as a universal eligibility or ERA identifier. Verify each connection independently; a claims code is not proof of another transaction. |
| ERA payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: No universal CALOP835 enrollment or routing value was established in the reviewed manual/EDI sources. The positively supported Office Ally claims reference remains separate from ERA receiver enrollment. |
| Timely filing | Product/administrator-specific; manual start-event conflict |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- 714-246-8600 remains the current Claims and Provider Resource Line and is identified in the manual for complex claims. The EDI page separately lists a claim-status contact; do not replace a valid provider-support number merely because a narrower route exists.
- The September 2026 CalOptima manual H2 describes 365 calendar days after the month of service for COD-A, CHCN and SRG claims, while H3 separately reminds providers of one year from service. OneCare and delegated-network responsibilities differ. The owner index says policies govern manual conflicts; confirm FF.2001 and the responsible administrator before using a deadline rather than treating these start events as equivalent.
- This registry has not established a payer-specific appeal ladder for CalOptima Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
- No universal CALOP835 enrollment or routing value was established in the reviewed manual/EDI sources. The positively supported Office Ally claims reference remains separate from ERA receiver enrollment.
CalOptima Health at a glance
| Legal name | Orange County Health Authority d/b/a CalOptima Health |
|---|---|
| Also known as | CalOptima, OCHA |
| Category | Medicaid MCO |
| Parent organization | Orange County (California) Health Authority (public) |
| Claims payer ID | The September 2026 manual H3 identifies Office Ally CALOP for professional CMS-1500 and facility UB claims, Change Healthcare 99250 for LTC/facility claims, and COLTC for long-term-care 25-1 billing. Apply only where CalOptima is financially responsible; delegated networks and OneCare professional claims can route elsewhere. |
| Eligibility (270/271) payer ID | CalOptima’s public EDI page documents 270/271 and 276/277 onboarding but does not establish CALOP as a universal eligibility or ERA identifier. Verify each connection independently; a claims code is not proof of another transaction. |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: No universal CALOP835 enrollment or routing value was established in the reviewed manual/EDI sources. The positively supported Office Ally claims reference remains separate from ERA receiver enrollment. |
| NAIC company code | Not established in this registry |
| States covered | California |
| Members covered | ~900k members |
| Provider resource entry point | https://www.caloptima.org/en/for-providers/provider-resources/manuals-policies-and-guides |
| Provider phone | 1-714-246-8600714-246-8600 remains the current Claims and Provider Resource Line and is identified in the manual for complex claims. The EDI page separately lists a claim-status contact; do not replace a valid provider-support number merely because a narrower route exists. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for CalOptima Health
The September 2026 CalOptima manual H2 describes 365 calendar days after the month of service for COD-A, CHCN and SRG claims, while H3 separately reminds providers of one year from service. OneCare and delegated-network responsibilities differ. The owner index says policies govern manual conflicts; confirm FF.2001 and the responsible administrator before using a deadline rather than treating these start events as equivalent.
| Submission type | Window |
|---|---|
| Initial claim reference | Product/administrator-specific; manual start-event conflict |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for CalOptima Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: CalOptima Health provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with CalOptima Health
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify CalOptima Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for CalOptima Health. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
- → https://www.caloptima.org/en/contact-us
- → https://www.caloptima.org/en/for-providers/interoperability-and-electronic-data-interchange
- → https://cop-p-001.sitecorecontenthub.cloud/api/public/content/dfb55018403942c29e96ed08aaae05d3?v=07622d8f
- → https://www.caloptima.org/en/for-providers/provider-resources/manuals-policies-and-guides
Top denial reasons for CalOptima Health
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient CalOptima Health volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | The September 2026 manual H3 identifies Office Ally CALOP for professional CMS-1500 and facility UB claims, Change Healthcare 99250 for LTC/facility claims, and COLTC for long-term-care 25-1 billing. Apply only where CalOptima is financially responsible; delegated networks and OneCare professional claims can route elsewhere. |
| 270 / 271 eligibility | Listed in registry; verify current scope | CalOptima’s public EDI page documents 270/271 and 276/277 onboarding but does not establish CALOP as a universal eligibility or ERA identifier. Verify each connection independently; a claims code is not proof of another transaction. |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: No universal CALOP835 enrollment or routing value was established in the reviewed manual/EDI sources. The positively supported Office Ally claims reference remains separate from ERA receiver enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- The September 2026 manual contains materially different filing start-event statements; applicable policies and product/administrator instructions need confirmation.
- CALOP is retained only as the manual’s Office Ally professional/facility claims reference. No eligibility/ERA scalar is inferred from it.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
field_status, provider_phone — CalOptima Contact Us
Source comparison: 2026-09-18
Source scope: Contact/transaction scope only; see record findings and exact source locator. Locator: Business: Claims and Provider Resource Line Version: Undated public HTML opened with web tool 2026-09-18; do not infer policy effective date from retrieval Retrieval: see source-specific inspection evidence; independent_peer_primary_public_source_read. Successful web tool open; no local HTML-byte claim CalOptima contact direct requests capture returned429; no retry and no token/header persistence. EDI direct capture omitted after contact rate limit. This is a partial source comparison, not whole-field or whole-record approval.
Primary source for field_status, provider_phone — caloptima contact usera_payer_id, field_status, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, provider_phone, transaction_scope — Interoperability and Electronic Data Interchange
Source comparison: 2026-09-18
Source scope: Contact/transaction scope only; see record findings and exact source locator. Locator: 270/271 and 276/277 roles; getting started; separate Claims-status telephone Version: Undated public HTML opened with web tool 2026-09-18; do not infer policy effective date from retrieval Retrieval: see source-specific inspection evidence; independent_peer_primary_public_source_read. Successful web tool open; no local HTML-byte claim CalOptima contact direct requests capture returned429; no retry and no token/header persistence. EDI direct capture omitted after contact rate limit. This is a partial source comparison, not whole-field or whole-record approval.
Primary source for era_payer_id, field_status, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, provider_phone, transaction_scope — interoperability and electronic data interchangeera_payer_id, field_status, filing_rule, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, provider_phone, timely_filing_days, timely_filing_source_url, transaction_scope — CalOptima Health Provider Manual
Source comparison: 2026-09-18
Source scope: H2 COD-A/CHCN/SRG365 calendar days after the service month differs from H3’s one-year-from-service reminder. Office Ally CALOP is professional/facility claims; Change 99250 is LTC/facility; COLTC is 25-1. These do not prove270/835 identifiers. Locator: Physical PDF 158H2, PDF 160–161H3 and PDF 335 revision Version: Last updated 09/2026. Retrieval: content_read; actual_public_pdf_download_text_and_scoped_visual_review. These pages actually rendered and inspected with view_image; other pages text-only or not reviewed. Not a whole-document review. This is a partial source comparison, not whole-field or whole-record approval.
Primary source for era_payer_id, field_status, filing_rule, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, provider_phone, timely_filing_days, timely_filing_source_url, transaction_scope — caloptima health provider manualfiling_rule, timely_filing_days, timely_filing_source_url — CalOptima manuals and policies index
Source comparison: 2026-09-18
Source scope: Policies and Procedures govern manual conflicts. Refer to FF.2001 and the responsible administrator rather than certify one generic filing clock. Locator: Notice and current Provider Manual link Version: No publication/effective date established on checked HTML. Retrieval: content_read; public_web_read. This is a partial source comparison, not whole-field or whole-record approval.
Primary source for filing_rule, timely_filing_days, timely_filing_source_url — caloptima manuals and policies index
Not checked in this pass: Unresolved fields from immutable field inventory: aka, appeal_levels, category, common_denial_risks, display_name, electronic_claims_supported, legal_name, lives_covered_millions, naic, parent_org, payer_ids, prior_auth_required_codes_sample, quickintell_workflow_fit, record_scope, source_review, states_covered, supports_278, supports_279_271; Whole-record approval, current legal entity/ownership, enrollment and complete insured geography; Every agreement, product, claim type, jurisdiction, filing/appeal exception and clinical authorization policy; Current transaction-specific enrollment/capabilities and authenticated portal behavior; unknown does not mean unavailable; QuickIntell integrations/outcomes, accountable approval and historical April2026 DataForSEO demand; last_reviewed/reviewed_by and prior field-level comparison dates remain unchanged.
Sources used for this guide
State coverage
CalOptima Health operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for CalOptima Health
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for CalOptima Health; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for CalOptima Health; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for CalOptima Health before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about CalOptima Health
Where is the CalOptima Health provider portal?
Use https://www.caloptima.org/en/for-providers/provider-resources/manuals-policies-and-guides as a starting point for CalOptima Health provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for CalOptima Health?
The September 2026 CalOptima manual H2 describes 365 calendar days after the month of service for COD-A, CHCN and SRG claims, while H3 separately reminds providers of one year from service. OneCare and delegated-network responsibilities differ. The owner index says policies govern manual conflicts; confirm FF.2001 and the responsible administrator before using a deadline rather than treating these start events as equivalent.
What is the CalOptima Health payer ID?
Claims: The September 2026 manual H3 identifies Office Ally CALOP for professional CMS-1500 and facility UB claims, Change Healthcare 99250 for LTC/facility claims, and COLTC for long-term-care 25-1 billing. Apply only where CalOptima is financially responsible; delegated networks and OneCare professional claims can route elsewhere.. Eligibility (270/271): CalOptima’s public EDI page documents 270/271 and 276/277 onboarding but does not establish CALOP as a universal eligibility or ERA identifier. Verify each connection independently; a claims code is not proof of another transaction.. ERA (835): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: No universal CALOP835 enrollment or routing value was established in the reviewed manual/EDI sources. The positively supported Office Ally claims reference remains separate from ERA receiver enrollment.. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does CalOptima Health accept electronic claims?
Verify CalOptima Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a CalOptima Health denial?
This registry has not established a payer-specific appeal ladder for CalOptima Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do CalOptima Health prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the CalOptima Health provider phone number?
This registry lists 1-714-246-8600 as a contact reference for CalOptima Health. 714-246-8600 remains the current Claims and Provider Resource Line and is identified in the manual for complex claims. The EDI page separately lists a claim-status contact; do not replace a valid provider-support number merely because a narrower route exists.
Automate workflows around CalOptima Health requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against CalOptima Health's current published documents before submission. CPT® is a registered trademark of the American Medical Association.