Providers Claims

Your Gateway to Claims

BH claims subThe 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.

claim status callout

Effective November 30, 2021 CenCal Health enhanced the Claims Entry and Search Module within the Provider Portal!  We strongly recommend submitting claims electronically for faster payment! 

Click the 'CenCal Health Portal' tab below to watch are new training tutorials or click here to watch additional Claims Training Tool Videos.

In addition, we also offer an easy and convenient way to view your Explanation of Payment (EOP) via the Provider Portal. Click here for more information.

weeklycalendar

electronic

claimspayElectronic:

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 Health Provider Portal

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.

Click here to access our Provider Portal User Guide for step by step instructions on how to utilize the portal today!

paper

paperPaper

Still Billing Paper? Listed below are the mailing addresses and the different claim forms accepted by CenCal Health.

Non-Pharmacy Claims:
CenCal Health

P.O. Box 948
Goleta, CA 93116-0948

Claim Forms Accepted:
CMS-1450 (UB-04) – institutional services
CMS-1500 – professional services


Pharmacy Claims:
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 Transfer (EFT)

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.

In order to receive EFT, providers must enroll for the option through our Provider Portal to receive electronic payments.  Please contact webmaster@cencalhealth.org if you need access to this section within the portal or email eft@cencalhealth.org for further details regarding your enrollment and/or deactivation.