How do physicians become part of the CHOC Health Alliance?
Please contact our Provider Services Department.
CHOC Health Alliance
Attn: Provider Relations
1120 W. La Veta Ave, #450
Orange, CA 92868
(800) 387-1103 Or Join Our Network
Where do providers send a claim?
For electronic claims submissions, the approved claims clearinghouses are Office Ally and Change Healthcare
| Payer ID: CHOC1 (866) 575-4120 www.officeally.com | Payer ID: 33065 or SCH01 (866) 363-3361 www.changehelathcare.com |
Paper claims and resubmissions (marked as resubmissions on the envelope), please mail to:
Rady Children’s Hospital – San Diego
Attn: CHOC/CPN Claims
P.O. Box 1598
Orange, CA 92856
Who do providers call with questions about a claim payment or claim status?
Providers should contact the Claim Research/Claim Inquiry Unit in our Claims Department at (800) 387-1103. Select option #1.
How do I find out who my provider representative is?
CHOC Health Alliance assigns every network a dedicated provider representative. Provider representatives are in regular contact with providers and/or office staff. Providers may confirm the name and phone number of their provider representative by calling the Provider Relations Department at (800) 387-1103 or Contact List
How do providers obtain authorizations from CHOC Health Alliance?
Providers may contact the Prior Authorization Unit seven days per week, 24 hours a day by calling (800) 387-1103. Providers may also fax requests for authorizations to CHOC Health Alliance at 1-855-867-0868 Prior Authorization Form – Microsoft Word – CHOC QRG 02.01.2022 v2.docx (chochealthalliance.com)
How do providers verify enrollment of a patient?
Proactively, Providers can check two systems for eligibility:
CalOptima Website; Provider Portal (caloptima.org)
CHOC Health Alliance Website; EZ-NET™ Login (rchsd.org)
CHOC Health Alliance Member Services Department, toll free at (800) 424-2462 is also available to verify enrollment.
What services are covered by CHOC Health Alliance?
Please refer to the Benefit Summary on this website for a brief description of covered benefits. For a more complete description of benefits, please refer to the Member Handbook also included on this website.
How can CalOptima members join CHOC Health Alliance?
Members may go directly to the CalOptima office or call CalOptima’s Customer Service Department and request a Health Network Selection form. CHOC Health Alliance’s Customer Service Department can help members complete this form if assistance is necessary.
CalOptima Health
505 City Parkway
West Orange, CA 92868
(714) 246-8500 or (888) 587-8088
What are carve-out services?
Carve-out services are services for which CHOC Health Alliance is not financially responsible. Carve-outs and the respective responsible organizations are listed below.
Vision Services Vision Services Plan (VSP)
(800) 877-7195
Dental Care DentiCal
(800) 766-7775
CalOptima Mental Health Services
(855) 877-3885
Pediatric Preventive Visits
(Use form PM-160) CHDP
CalOptima
PPS/CHDP Claims
P.O. Box 11037
Orange, CA 92856
What is California Children Services (CCS)? How do providers sign up?
California Children Services (CCS) is a state program for children under 21 whose medical conditions qualify them for CCS assistance. Children that meet medical, residential and financial criteria (as defined by CCS) are eligible for diagnostic evaluations, treatment services, case management, and physical/occupational therapy services. Please contact CCS for more information.
California Children Services
PO Box 6099
Santa Ana, CA 92706
https://www.dhcs.ca.gov/services/Pages/cms.aspx
What is the Child Health and Disability Prevention (CHDP) program? How do providers bill for services?
The Child Health and Disability Prevention (CHDP) program is a preventive health program serving California’s children and youth. CHDP provides periodic preventive health services to Medi-Cal beneficiaries under the regulations of the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. All California Medi-Cal recipients from birth to age 21 are eligible for health assessments. CHOC Health Alliance requires all providers rendering treatment to patients under 21 to be CHDP certified. You may contact the Provider Relations Department to obtain a schedule of training sessions in order to become certified. The phone number is (800) 387-1103.
Claims should be submitted to CalOptima:
CalOptima
PPS/CHDP Claims
P.O. Box 11037
Orange, CA 92856
