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Member Handbook (EOC)

Select your health plan to view the Member Handbook (EOC)

Medi-Cal

Public program for low income people

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CommuniCare Advantage

Medicare and Medi-Cal benefits

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Community y Más

Medicare plan for chronic care needs

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Submit a Claim

Resources for Providers

How to submit a claim

Thank you for taking care of Community Health Group members. To ensure timely processing and payment of claims, we encourage you to submit claims via EDI using one of the clearinghouses below. Both contracted and non-contracted providers may submit claims to Community Health Group via EDI.

For more information related to electronic claim submissions, please refer to
CHG’s EDI Companion Guide

Sender IDClearing House NameLine Of BusinessPayment TypePayer IDClaim TypeERA
133052274Emdeon/OptumAllSame for both66170Professional and InstitutionalYes
263923727Gateway/TrizettoAllSame for both95376Professional and InstitutionalYes
263923727Gateway/TrizettoAllSame for bothU5376InstitutionalYes
581651222Optum (Formerly Change Health, Relay Health)AllSame for both7110ProfessionalYes
581651222Optum (Formerly Change Health, Relay Health)AllSame for both7668InstitutionalYes
611358935Zirmed/WaystarAllSame for bothZ1700Professional and InstitutionalYes
330897513Office AllyAllCapitated66171ProfessionalYes
330897513Office AllyAllFee For Service66170Professional and InstitutionalYes
300001057Cortex EDIMedi-CalSame for bothCX057Professional and InstitutionalYes
300001057Cortex EDIMedicareSame for bothCX058Professional and InstitutionalYes
432018849Med Assets EDI Service/FinThriveAllSame for both95376Professional and InstitutionalYes
800238572Turbo TarAllSame for both953766170Professional and InstitutionalYes
ZOTECZOTECAllSame for both953766170ProfessionalYes

Non-Contracted Providers

Alternatively, if you are a non-contracted provider, you may mail your claims to the following address:

Medi-Cal Claims:
Community Health Group
PO Box 210100
Chula Vista, CA 91921

Medicare Claims:
Community Health Group
PO Box 210157
Chula Vista, CA 91921

First time submitting a claim

If you are submitting claims to Community Health Group for the first time, please make sure to attach your W-9 form and NPI to avoid delays in the processing of claims and correspondence.

You may send this via email at providerenrollment@chgsd.com, fax at (619)382-1214, or mail out to:

Community Health Group
Attn: Provider Enrollment
2420 Fenton St., Suite 100
Chula Vista, CA 91914

Non-Contracted Provider Accepted Codes and Reimbursement

The links below contain codes that are considered covered benefits for the Medi-Cal product line. This information is provided by the California Department of Health Care Services (DHCS) as information only for provider reference. CHG will reimburse non-contracted providers at the Medi-Cal rates and apply Medi-Cal guidelines for claims processing.

More Resources