CalViva Health Medi-Cal Provider Services Department
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As a prepaid health care delivery system, CalViva Health has some unique characteristics that make timely response and accurate information necessary. If prompt and accurate information is not provided, a member may misuse the program, resulting in medical services not being covered. To avoid this, CalViva Health directs inquiries from providers to CalViva Health's Medi-Cal Provider Services Department or to CalViva Health's Provider Engagement Network Specialists, where available. Members are directed to the Medi-Cal Member Services Department.
CalViva Health's Medi-Cal Provider Services Department Customer Service Advocates are available 24 hours a day, 7 days a week, to assist providers with:
- Member eligibility, effective dates, and eligibility research
- Primary care physician (PCP) selection and transfer requests for members
- Questions about the CalViva Health Medi-Cal Recommended Drug List (RDL)
- Benefit information
- Professional and hospital billing
- Claims
- Questions regarding claims status
- Exceptions and administrative decisions
- Complaints and grievances regarding provider care, delivery of care or participating physician group (PPG) staff
- Requests for removal/ PCP/PPG reassignment for non-compliant members
The CalViva Health Medi-Cal Provider Services Department phone number 888-893-1569, option 2.
Fax: 844-837-5947 or 800-281-2999
Eligibility and claims status available online.
Provider’s may use the Medi-Cal Claims Inquiry email box for claim status only if the provider portal is down or not working. This box is only for claim status and denial inquiries.