Provider Portal

The Gold Coast Health Plan (GCHP) Provider Portal provides online access to member eligibility information, the ability to enter authorization requests and check status of authorizations, and to check the status of claims. Office managers request and maintain user privileges for themselves and for office staff.

PLEASE READ:

• Beginning in December, GCHP will implement a new claims system to better serve providers. As a result of the system conversion, several functions and documents will change. Click here for more information.
  
  
• Starting Jan. 1, 2021, the state Department of Health Care Services (DHCS) will carve out all prescription benefits from Managed Care Plans (MCP) under a new program called Medi-Cal Rx. Upon implementation, all pharmacy claims will be submitted directly to the state via its pharmacy benefit manager (PBM), Magellan Medicaid Administration, Inc. Click here for more information.

Access the Provider Portal

For help, view the Provider Portal User Guide.

Portal Special Information

Providers will need their IKA provider or professional number to register at the portal. Also:

• The Reset User function (administrator only) is no longer its own tab but a sub-choice on the Manage Users tab.
• The authorization search has been expanded by adding the following additional search screens:
  • Service Type.
  • Service Location.
  • Authorization Status.
  • Authorization Type.
  • Receive Date Range.
  • Primary Diagnosis.
• The maximum number of authorizations returned on a search is 300.
• The maximum number of claims returned on a search is 300.
• Providers having problems with portal registration or providers who need their IKA provider or professional number can email ProviderRelations@goldchp.org. Please include the name of the provider, the provider type, NPI number and tax ID number.
• When registering using the tax ID number do not include the hyphen, only include the numbers.
• When entering the member ID only use the GCHP ID number, which is the first nine (9) digits (8 numbers and 1 letter) of their BIC.
• The following features are NOT currently available through the Provider Portal:
  • Attachments cannot be made to authorizations or claims.
  • Section 1.13. Submission of UBs and HCFAs, has been removed from the Provider Portal User Guide. UBs and HCFAs cannot currently be submitted through the Provider Portal. Until this feature is available, paper claims and electronic claims through EDI Direct will be accepted.
• When validating eligibility, Default PCP means the member has not been assigned a Primary Care Provider. Providers can have members complete the PCP Selection Form. Completed forms can be faxed to Gold Coast Health Plan PCP Assignment at 1.888.310.3660.