CalOptima

Summary

CalOptima is a Medicaid managed care organization, part of CalOptima Health, offering dental and medical coverage operating in California. Claims route under payer ID CALOP, with 7 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through CalOptima Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and activates within hours.

At a glance

Payer ID

CALOPAlso seen as 059, 101160, 10972, 2903, 4221, 5914 and 1 more

Also known as

CalOptima Direct, CalOptima Health

Uses CAQH

YesApplication route: Payer portal application

Service area

CA (Orange County)

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Common questions

What is the payer ID for CalOptima?

The payer ID for CalOptima is CALOP. Alternate IDs seen across clearinghouses include 059, 101160, 10972, 2903.

How long does CalOptima provider enrollment take?

CalOptima provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does CalOptima require CAQH?

Yes. CalOptima uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does CalOptima require ERA enrollment?

Yes. CalOptima requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes a few hours.

What states does CalOptima cover?

CalOptima operates in CA (Orange County). Coverage can differ by plan and product line, so confirm the specific plan before you file.