CalViva Health Medi-Cal Provider Services Center
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 Center or to CalViva Health's regional provider network administrators, where available. Members are directed to the Medi-Cal Member Services Department.
CalViva Health's Medi-Cal Provider Services Center representatives are available 24 hours a day, seven 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 Recommended Drug List (RDL).
- Benefit information.
- Professional and hospital billing.
- 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 of members or with disciplinary actions.
The CalViva Health Medi-Cal Provider Services Center toll-free telephone number is printed on the back of the member's identification card. It is the responsibility of the servicing provider to confirm eligibility at the time of service.
21281 Burbank Boulevard, C-5
Woodland Hills, CA 91367
1-888-893-1569, option 2
Fax: (818) 676-5387 or 1-800-281-2999
Eligibility and claims status available online at provider.healthnet.com
Eligibility and billing inquiries: HNMedi-cal.Eligiblity@healthnet.com
Claim status and denial inquiries: HNMedi-cal.ClaimsInquiry@healthnet.com
Capitated claims/nonpayment: HNMedi-cal.ProviderBilling@healthnet.com