1. How do physicians become part of the CHOC Health Alliance?
2. Where do providers send a claim?
3. Who do providers call with questions about a claim payment or claim status?
4. How do providers order a current Provider Manual, Directory and/or Preferred Drug List?
5. How do I find out who my provider representative is?
6. How do providers obtain authorizations from CHOC Health Alliance?
7. How do providers verify enrollment of a patient?
8. What services are covered by CHOC Health Alliance?
9. How can CalOptima members join CHOC Health Alliance?
10. What are carve-out services?
11. What is CCS? How do providers sign up?
12. What is CHDP? How do providers bill for services?

1) How do physicians become part of the CHOC Health Alliance?

Please contact our Provider Relations Department for an application.

CHOC Health Alliance
Attn: Provider Relations
1120 W. La Veta Ave, #450
Orange, CA 92868
(714) 565-5100

2) Where do providers send a claim?

CHOC Health Alliance
Attn: Claims Department
P.O. Box 62108
Phoenix, AZ 85082-2108

Resubmissions should be sent to the same address – marked as resubmissions on the envelope.

3) 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.

4) How do providers order a current Provider Manual, Directory and/or Preferred Drug List?

Providers may call the Provider Relations Department at (714) 565-5100, or contact their assigned provider representative. A copy of the preferred drug list is included on this web site.

5) How do I find out who my provider representative is?

CHOC Health Alliance assigns every network provider a 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 (714) 565-5100.

6) How do providers obtain authorizations from CHOC Health Alliance?

Providers may contact the Prior-Authorization Unit seven days per week, 24 hours per day by calling (800) 387-1103. Providers may also fax requests for authorizations to CHOC Health Alliance at (714) 565-5167.

7) How do providers verify enrollment of a patient?

Contact our Member Services Department at (714) 835-9627 or (800) 424-

2463 to verify enrollment.

8) What services are covered by CHOC Health Alliance?

Please refer to the benefit summary page on this Web site for a brief

description of covered benefits. For a more complete description of benefits, please refer to the member handbook also included on this Web site.

9) 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
1120 W. La Veta Ave., 2nd Floor
Orange, CA 92868
(714) 246-8500 or (888) 587-8088

10) 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.

11) 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
http://www.dhs.ca.gov/pcfh/cms/HTML/CCS.htm

12) 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 (714) 565-5100.

Claims should be submitted to CalOPTIMA:
CalOPTIMA
PPS/CHDP Claims
P.O. Box 11037
Orange, CA 92856