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 contact us.
For electronic claims submissions, the approved claims clearinghouses are: Office Ally, Emdeon, RelayHealth.
Paper claims and resubmissions (marked as resubmissions on the envelope), please mail to:
Rady Children’s Hospital San Diego
Attn: CHOC/CPN Claims
3020 Children’s Way, Mail Code 5144
San Diego, CA 92123
Providers should contact the Claim Research/Claim Inquiry Unit in our Claims Department at (800) 387-1103. Select option #1.
Providers may call the Provider Services Department at (800) 387-1103, or contact their assigned provider representative. A copy of the preferred drug list is included on this website.
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.
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.
Proactively, Providers can check three systems for eligibility:
CalOptima Website;
CHOC Health Alliance Website;
The California State System (this site’s data is usually 30-45 days behind)
CHOC Health Alliance Member Services Department, toll free at (800) 424-2462 is also available to verify enrollment.
Please refer to the Benefit Summary page 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.
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
505 City Parkway
West Orange, CA 92868
(714) 246-8500 or (888) 587-8088
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
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
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
