Your Gateway to Claims
The Claims Team is dedicated to supporting our Provider Community through our excellent customer service. Our goal is to adjudicate your claims in an accurate, timely and efficient manner using highly-trained and dedicated employees. We are here and ready to help!
Submit a Claim Now!
Still using paper to submit claims? CenCal Health makes it easy for you to submit a claim. We have three ways to do so. Faster, easier, and direct. Please choose from one of the three tabs below to learn how to submit via our EDI clearing house, the CenCal Health Provider Portal, or via paper.
We also offer an easy and convenient way to view your Explanation of Payment (EOP) via the Provider Portal. Click here for more information.
To find out more about submitting claims electronically to CenCal Health, please contact the EDI team at CenCal Health.
If you are currently submitting electronically to CenCal Health you can reference the CenCal 5010 Companion Guide, and the Trading Partner Worksheet.
Please email CenCal Health’s EDI Workgroup for further information.
File Transport Security
CenCal Health supports file transfers by FTP, FTPS and SFTP. If sending files using FTP, the files must be secured using PGP. Click here to download CenCal Health’s public key.
CenCal Provider Portal Restricted Site
CenCal Health has implemented electronic billing through our web portal. Submitting a “clean claim” is important in order for your claim to be considered by CenCal Health for payment. These tutorials will teach you how to utilize the main Claims Entry Home Screen Dashboard, enter a CMS-1500 Claim Form, and a UB-04 Claim Form. Visit our Provider Portal to get started.
- Claims Dashboard Video Tutorial
- CMS 1500 Claim Entry Video Tutorial
- UB-04 Claim Entry Video Tutorial
- Claims Status Report Video Tutorial
Click here to access our Provider Portal User Guide for step by step instructions on how to utilize the portal today!
Still Billing Paper? Listed below are the mailing addresses and the different claim forms accepted by CenCal Health.
P.O. Box 948
Goleta, CA 93116-0948
Claim Forms Accepted:
CMS-1450 (UB-04) – institutional services
CMS-1500 – professional services
MedImpact Healthcare Systems, Inc.
Operations Department, Attn: Claims
10181 Scripps Gateway Ct.
San Diego, CA 92131
Claim Form Accepted:
Pharmacy Claim Form 30-1
Electronic Fund Transfers (EFT) is a method of bi-monthly payment offered by CenCal Health to our participating contracted providers, this free service provides convenience and savings.
EFT automatically credits payments due for healthcare services performed directly to your savings or checking account. This payment method replaces issuing a paper check for various payment types, including or related to claims processing, i.e. EOPs, Capitation and Incentive payments.
CenCal Health is pleased to announce that beginning on November 1, 2022, we are partnering with Wells Fargo to manage the enrollment and update process for Automated Clearing House (ACH), also known as Electronic Funds Transfer (EFT).
Effective November 1, 2022, all new requests to enroll in or change your EFT information will be processed by Wells Fargo via their Supplier Analysis and Onboarding platform. Providers not currently enrolled in EFT will soon receive an “ACH Outreach” letter from Wells Fargo with instructions on how to enroll. CenCal Health recommends all providers enroll in EFT to ensure that you continue to receive timely payments, increase fraud protection, and simplify reconciliation.
This change will not impact providers who are already enrolled in EFT with CenCal Health unless you are making an update to your EFT information after this date. Claim payment information continues to be available through our Provider Portal.
Please do not hesitate to contact our CenCal Health Provider Services Department with questions at email@example.com or by phone at (805) 562-1676.