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
1-833-236-4141
| 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 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)