Your Gateway to Claims

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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

weeklycalendarStill 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.

CenCal Health strongly recommends submitting claims electronically. This allows faster payment with clean claims.

Claims Payment

CenCal Health now offers an easy and convenient way to view your Explanation of Payment (EOP) via the Provider Portal. Click here for more information.

electronic

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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 website

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CenCal Website

CenCal Health has implemented electronic billing through our web portal. It is fast and easy. In our website portal, you can edit claims at the time of entry to assure claims are clean and ready for payment. Visit our Provider Portal to get started.


paper

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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 a weekly payment offered by CenCal Health to our participating contracted providers, this free service provides convenience and savings.

EFT automatically credits any 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 (PCP Incentive Program, Inpatient Readmission Program, Diabetes SMART Program and the Breathe (Asthma) SMART Program).

In order to receive EFT, providers must enroll for the option through our Provider Portal to receive electronic payments. Below are additional resources to determine if this program will benefit your practice or clinic.

What are the benefits of using EFT?  Using EFT reduces paper processing and the errors associated with such processing. It also reduces costs related to check processing and postage and allows for faster response times to inquiries regarding the status of payments. You are able to see all payments related to a checks through the Provider Portal.

Is EFT required or voluntary?  CenCal Health strongly recommends Electronic Funds Transfer (EFT) and electronic Explanation of Payment (EOP). Once enrolled, EFT deposits are received weekly!

Is my EFT bank account information secure?  Yes, all EFT data is SSL 128-bit data encrypted. Access to EFT bank account information is restricted to a limited number of plan staff. In addition, EFT bank information is more secure than a paper check, which can pass through many different hands.

How do I enroll?  Providers can enroll for EFT through the ‘Electronic Funds Transfer’ section of our website (user job role must be included in your individual user access). Please contact your portal Physician/Administrator if you need access to this section of the portal.

Once a provider's enrollment has been submitted through the portal, a notification to the authorized person at the practice will be required to confirm the information submitted within two (2) business days. Once confirmed, CenCal Health will initiate two (2) verification transactions (two deposits totaling $0.25) to each bank account enrolled. The assigned user will be able to update the two deposit amounts themselves with EFT access on the provider portal. Once verified the provider will be fully enrolled in the EFT program and begin to receive selected payments electronically.

Please note: In order to track EFT transactions to bank statement(s) and/or to electronic remittance advice (835 files), providers will need to contact their financial institution and request that the Transaction Reassignment Number (TRN) be added to their statements for these transactions. This request should only need to be made once.

All non-participating providers not contracted with CenCal Health will need to sign-up for this method of payment via the paper EFT Enrollment Form

What information do I have to provide in order to sign up for EFT?  Providers enroll in EFT under each NPI for which payments will be made. Providers will need to provide their NPI, contact information for an authorized EFT individual within your practice, and bank information to include routing number, bank name and bank account number. If providers can select more than one payment type (PCPs) and would like their various payments sent to different bank accounts, they can authorize a different account for each payment type.

After my enrollment, when will I receive my first transfer?  When all of the steps listed above are completed, and verified by CenCal Health, your first payment will be received two (2) business days after the payment has been initiated.  A one time verification confirmation will be sent to the authorized person at your practice via email confirming that all payments will now be received electronically to your bank after payment is initiated (ACH payments require two days to process).

Can I view a history of payments previously made on the website?  Contracted providers with access can pull all EOP’s on the portal. You are also able to view this on the Claims section of the portal and download to a CSV file.

Who do I contact to deactivate the account, payment failure emails, status of the enrollment, and/or make changes to our account?  CenCal Health will continue to send payments to the Financial Institution indicated until notified by Provider/Submitter of a change of the Financial Institution authorized to receive payments. The Provider Portal ‘EFT’ section of the website will allow the assigned user to ‘Edit’ or ‘DeActivate’ your EFT enrollment account(s).

If Financial Institution information changes, or you receive payment failure, or for general questions, please notify CenCal Health via email at eft@cencalhealth.org or contact our Finance Department at (805) 562-1081.