Partner With Us
Provider Services Line:
1-888-671-6419
Provider Services E-mail:
chpivprov@chgsd.com
Access Provider Portal:
chpivproviderportal.org
| How to file a Provider Grievance |
|---|
| Detailed instructions on filing a provider grievance: Provider Grievances Process Download – Provider Dispute Resolution (PDR) Request Download – Waiver of Liability Statement Note: Provider grievances may be submitted orally or in writing within 180 days of the date of occurrence. |
Submit a Claim
Provider claims for Community Health Plan of Imperial Valley should be submitted to:
CHPIV Advantage Plus
ATTN: Claims Department
P.O. Box 174
Imperial, CA 92251
| Sender ID | Clearing House Name | Line Of Business | Payment Type | Payer ID | Claim Type | ERA |
|---|---|---|---|---|---|---|
| 133052274 | Emdeon/Optum | All | Same for both | 66170 | Professional and Institutional | Yes |
| 263923727 | Gateway/Trizetto | All | Same for both | 95376 | Professional and Institutional | Yes |
| 263923727 | Gateway/Trizetto | All | Same for both | U5376 | Institutional | Yes |
| 581651222 | Optum (Formerly Change Health, Relay Health) | All | Same for both | 7110 | Professional | Yes |
| 581651222 | Optum (Formerly Change Health, Relay Health) | All | Same for both | 7668 | Institutional | Yes |
| 611358935 | Zirmed/Waystar | All | Same for both | Z1700 | Professional and Institutional | Yes |
| 330897513 | Office Ally | All | Capitated | 66171 | Professional | Yes |
| 330897513 | Office Ally | All | Fee For Service | 66170 | Professional and Institutional | Yes |
| 300001057 | Cortex EDI | Medi-Cal | Same for both | CX057 | Professional and Institutional | Yes |
| 300001057 | Cortex EDI | Medicare | Same for both | CX058 | Professional and Institutional | Yes |
| 432018849 | Med Assets EDI Service/FinThrive | All | Same for both | 95376 | Professional and Institutional | Yes |
| 800238572 | Turbo Tar | All | Same for both | 953766170 | Professional and Institutional | Yes |
| ZOTEC | ZOTEC | All | Same for both | 953766170 | Professional | Yes |
Provider Services line: 1-888-671-6419
Provider Services e-mail: chpiv.prov@chgsd.com
To access your provider portal, please login at chpivproviderportal.org.
Download the Provider Manual
Download the Referral and Service Request Form
Download the Community Support (CS) Referral Form
Download the NEMT – Physician Certification Statement Form
Download the CHPIV Authorization No Authorization List
Formularies
Download the List of Covered Drugs (Formulary) (English)
Download the List of Covered Drugs (Formulary) (Spanish)