CalViva Health at a glance
| Legal name | CalViva Health |
|---|---|
| Also known as | CalViva |
| Category | Medicaid MCO |
| Parent organization | — |
| Claims payer ID | CalViva’s claims page lists 95567 for Medi-Cal claims. This reference does not establish the separate Dual Align Medicare product route. |
| Eligibility (270/271) payer ID | The same page distinguishes Ability (MDOnline) 95567 from Availity 68069 for eligibility/claim-status functions. Keep universal eligibility and ERA scalars unknown rather than flatten these vendor roles. |
| 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: This registry has not established one national ERA payer ID for CalViva Health. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | California |
| Provider resource entry point | https://www.calvivahealth.org/providers |
| Provider phone | 1-888-893-1569888-893-1569 is Member and Provider Services for CalViva Medi-Cal in Fresno, Kings and Madera counties. Wellcare CalViva Health Dual Align has a separate contact; this is not a universal Medicare route. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for CalViva Health
CalViva’s currently linked 2026 provider training gives 180 days from the last day of the month of service for initial Medi-Cal claims. Its 365-day requested-information and provider-dispute contexts are separate. Confirm the Provider Participation Agreement and current operations guidance; do not start this initial clock on the service date itself.
| Submission type | Window |
|---|---|
| Initial claim reference | Medi-Cal initial claims: 180 days after service-month end |
| 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 CalViva 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: CalViva Health provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with CalViva 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 CalViva 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 CalViva 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://calvivahealth.org/about-calviva/
- → https://calvivahealth.org/contact-us/
- → https://calvivahealth.org/providers/claims/
- → https://www.healthnet.com/content/dam/centene/healthnet/pdfs/provider/ca/provider-engagement/hn-calviva-new-existing-provider-training-2026.pdf
- → https://www.healthnet.com/content/healthnet/en_us/providers/training/new-provider-training.html
Top denial reasons for CalViva Health
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient CalViva 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 | CalViva’s claims page lists 95567 for Medi-Cal claims. This reference does not establish the separate Dual Align Medicare product route. |
| 270 / 271 eligibility | Listed in registry; verify current scope | The same page distinguishes Ability (MDOnline) 95567 from Availity 68069 for eligibility/claim-status functions. Keep universal eligibility and ERA scalars unknown rather than flatten these vendor roles. |
| 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: This registry has not established one national ERA payer ID for CalViva Health. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before 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
- CalViva’s Medi-Cal service area is the three named counties, not all California products. RHA sponsorship and the Health Net network-services contract have distinct roles.
- Initial claims use the training’s service-month-end start event. Vendor-specific eligibility references must not be treated as one universal 835 identifier.
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.
parent_org, states_covered — About CalViva Health
Source comparison: 2026-09-18
Source scope: Medi-Cal local initiative for Fresno, Kings and Madera, sponsored by Regional Health Authority. This does not establish Health Net parent ownership. Locator: Local Initiative Plan and RHA sponsorship 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 parent_org, states_covered — about calviva healthfield_status, provider_phone — CalViva contact information
Source comparison: 2026-09-18
Source scope: 888-893-1569 is Medi-Cal member/provider services for the three counties. Dual Align has separate contact information. Locator: Medi-Cal Only Member/Provider Services versus Dual Eligible 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 field_status, provider_phone — calviva contact informationera_payer_id, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, transaction_scope — CalViva claims and electronic services
Source comparison: 2026-09-18
Source scope: Claims 95567; eligibility/status uses Ability (MDOnline) 95567 versus Availity 68069. No universal ERA value is inferred. Locator: Claims and eligibility/claim-status tables 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 era_payer_id, payer_ids, payer_ids.claims, payer_ids.eligibility, payer_ids.era, transaction_scope — calviva claims and electronic servicesfield_status, filing_rule, parent_org, provider_phone, states_covered, timely_filing_days, timely_filing_source_url — CalViva2026 provider training
Source comparison: 2026-09-18
Source scope: Health Net Community Solutions provides network services by contract. Initial Medi-Cal filing is 180 days from service-month end;365-day requested-information/dispute contexts are separate. Locator: Physical PDF 2 network contract; PDF 6 RHA sponsorship; PDF 37 claim submission Version: 2026 training; current owner onboarding index updated July 16, 2026; actual PDF metadata December 1, 2025. 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 field_status, filing_rule, parent_org, provider_phone, states_covered, timely_filing_days, timely_filing_source_url — calviva2026 provider trainingSource version and inspection boundary — Health Net/CalViva onboarding resources
Source comparison: 2026-09-18
Source scope: The current owner index supplies the actual provider-engagement PDF path. The old indexed root path returned404 and was not used. Locator: CalViva2026 Training Guide link Version: Updated July 16, 2026. Retrieval: content_read; public_web_read. This is a partial source comparison, not whole-field or whole-record approval.
Primary source for source version and inspection boundary — health net/calviva onboarding resources
Not checked in this pass: Unresolved fields from immutable field inventory: aka, appeal_levels, category, common_denial_risks, display_name, electronic_claims_supported, era_payer_id, legal_name, lives_covered_millions, naic, payer_ids, payer_ids.eligibility, payer_ids.era, portal_url, 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
CalViva 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 CalViva 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 CalViva Health; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for CalViva Health; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for CalViva Health before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about CalViva Health
Where is the CalViva Health provider portal?
Use https://www.calvivahealth.org/providers as a starting point for CalViva 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 CalViva Health?
CalViva’s currently linked 2026 provider training gives 180 days from the last day of the month of service for initial Medi-Cal claims. Its 365-day requested-information and provider-dispute contexts are separate. Confirm the Provider Participation Agreement and current operations guidance; do not start this initial clock on the service date itself.
What is the CalViva Health payer ID?
Claims: CalViva’s claims page lists 95567 for Medi-Cal claims. This reference does not establish the separate Dual Align Medicare product route.. Eligibility (270/271): The same page distinguishes Ability (MDOnline) 95567 from Availity 68069 for eligibility/claim-status functions. Keep universal eligibility and ERA scalars unknown rather than flatten these vendor roles.. ERA (835): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for CalViva Health. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does CalViva Health accept electronic claims?
Verify CalViva 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 CalViva Health denial?
This registry has not established a payer-specific appeal ladder for CalViva 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 CalViva 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 CalViva Health provider phone number?
This registry lists 1-888-893-1569 as a contact reference for CalViva Health. 888-893-1569 is Member and Provider Services for CalViva Medi-Cal in Fresno, Kings and Madera counties. Wellcare CalViva Health Dual Align has a separate contact; this is not a universal Medicare route.
Automate workflows around CalViva 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 CalViva Health's current published documents before submission. CPT® is a registered trademark of the American Medical Association.