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. View the EOP Instructional PDF to access more information.
Claims Assistance
Contact the CenCal Health Claims Assistance group to receive support for your claims. Call (805) 562-1083 Monday-Friday from 8:30AM-4:00PM to get support.
- CenCal Health’s Behavioral Health Integration Webpage
- CenCal Health’s Claims Status Search
- 2026 Weekly EOP Payment Schedule
Electronic:
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
Visit our Provider Portal User Guide for step by step instructions on how to utilize the portal today!
PAPER
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
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.
Please do not hesitate to contact our CenCal Health Provider Services Department with questions at [email protected] or by phone at (805) 562-1676.
Taxonomy Code Requirements for Claims Submission
CenCal Health reminds all providers to submit the appropriate taxonomy code associated with the billing and attending/rendering National Provider Identifier (NPI) on institutional and professional claims. Including taxonomy codes supports accurate provider identification, improves data quality, and helps avoid potential claims processing delays.
A taxonomy code is a unique 10-character code established and maintained by the National Uniform Claim Committee (NUCC). It identifies a provider’s grouping, classification, and area of specialization. If a provider is associated with more than one taxonomy code, the taxonomy code submitted on the claim should most accurately reflect the group and specialty classification of the service rendered.
Validate Your Taxonomy Code
Providers may validate the taxonomy code associated with their NPI and practice location through the Provider Application and Validation for Enrollment (PAVE) Portal. Providers are encouraged to confirm their taxonomy information before submitting claims.
Institutional Claims
For paper claim submissions using the Universal Billing (UB-04) claim form, taxonomy codes should be reported as follows:
- Billing Provider Taxonomy Code: Field 81CCa (Code-Code) with Qualifier “B3” (Healthcare Provider Taxonomy Code)
- Attending Provider Taxonomy Code: Field 81CCb (Code-Code) with Qualifier “B3”
For electronic claim submissions using the ASC X12N 837 Institutional Transaction, taxonomy codes should be reported as follows:
- Billing Provider Taxonomy Code: Loop 2000A (Billing Provider Hierarchical Level, Billing Provider Specialty Information)
- Attending Provider Taxonomy Code: Loop 2310A (Attending Provider Name, Attending Provider Specialty Information)
Professional Claims
For paper claim submissions using the CMS-1500 claim form, taxonomy codes should be reported as follows:
- Billing Provider Taxonomy Code: Field 33b (Non-NPI Number/Other ID) with Qualifier “ZZ” (Provider Taxonomy)
- Rendering Provider Taxonomy Code: Field 24J (Rendering Provider ID) shaded area, with the Rendering Provider Taxonomy Code Qualifier entered in Field 24I using Qualifier “ZZ” (Provider Taxonomy)
For electronic claim submissions using the ASC X12N 837 Professional Transaction, taxonomy codes should be reported as follows:
- Billing Provider Taxonomy Code: Loop 2000A (Billing Provider Hierarchical Level, Billing Provider Specialty Information)
- Rendering Provider Taxonomy Code: Loop 2310B [Rendering Provider Name (Claim Level), Rendering Provider Specialty Information] or Loop 2420A [Rendering Provider Name (Service Line Level), Rendering Provider Specialty Information]
Contact Us
For questions or additional assistance, please contact the Claims Customer Service Team at 805-562-1083.