Support for the people who support our members
Login to OPIS
Our provider tools and dedicated support make it easier to access patient information, get answers, and keep care moving forward.
Provider support without the runaround
When you’re helping a patient, you don’t have time to chase down eligibility, claim details, or benefit information. We get it, and we built our provider tools to make the next step easier.
Use OPIS for quick self-service access, call our provider support line when you need guided help, or connect with our team about network participation. However you reach us, we’ll help you get to the right information with less back-and-forth.
Fast answers start with OPIS
When you need patient or claim information, our web Online Provider Information System (OPIS) helps you get there without the extra runaround. It’s our secure, HIPAA-compliant provider portal built to give your team 24/7 access to the details that keep care, billing, and follow-up moving.
OPIS is available at no cost to providers. Once registered, your account shows information tied to your submitted Tax ID, so your team can quickly find the member, plan, and claim details relevant to your practice.
Verify patient eligibility
Confirm whether a member’s coverage is active and view the most current effective date on file. You can search using the main subscriber’s Healthcare ID number or Social Security number.
Review member details
Access family summary and individual member detail screens to understand who is covered, which plan applies, and what information is connected to the submitted Tax ID.
Check claim status
View claim summary and claim detail information, including where a claim stands and the details available for follow-up or payment review.
Review patient correspondence
Find patient-related communications in one place, making it easier to track plan communications and respond when additional follow-up is needed.
View electronic remittance advice
Access electronic remittance information to support reconciliation, payment posting, and cleaner billing workflows.
Review plan text and plan history
Look up plan language, benefit details, limitations, requirements, and plan history so your team can better understand how coverage applies.
Join the Cedar Health Network
Cedar Health Network is our supplemental EPO network built around access, coordination, and practical care for the members we serve. We choose participating providers based on proximity to members and employer groups in select areas, helping create a more connected care experience where our members live and work.
As a participating provider, you play an important role in helping members access quality care at a reasonable cost. That includes supporting timely appointments, clear communication, and accurate practice information so members know where to go and what to expect.
Helpful resources
Here’s a quick menu of forms that providers use most to work with when working with us and our members.
Utilization Management Authorization Form
Use this form for services that require prior review and approval before care is provided.
Web OPIS User Manual
Introduction to Web Online Provider Information System.
Cedar Health Network Provider Manual
A guide for Cedar Health Network providers covering care standards, credentialing, claims, and network procedures.
Cedar Health Network Provider Application Form
A form for providers applying to join the Cedar Health Network, including provider, credentialing, location, and professional information.
FAQs
Get quick answers to common provider questions about claims, coverage, and our services.
Registration is quick:
1. Visit webopis.pinnacle-health.com
2. Select Register Now
3. Complete the registration form and submit it
4. Accept the terms of use
Confirm your account through the access link sent by email
Once your account is confirmed, you can begin using Web OPIS.
Providers should submit claims electronically using Payer ID #24735. Paper claims can be mailed to:
Pinnacle Health Solutions, Inc.
PO Box 2220
Newport Beach, CA 92658
This information is also available on the member’s ID card.
Providers can verify member eligibility through the OPIS provider portal or by contacting Pinnacle’s call center.
If you believe there is a billing error or suspect fraudulent activity, contact Customer Service as soon as possible. Our team will review the issue, investigate the concern, and help determine any necessary next steps.
Providers can submit claims to Pinnacle electronically, often using Electronic Data Interchange (EDI). Claims may be sent directly to Pinnacle for processing and payment, or routed through a network or clearinghouse, which may then forward the claim to Pinnacle for adjudication and payment processing. The specific workflow can vary depending on network arrangements and client-specific customizations, but electronic submission is supported and commonly used.
Pinnacle can administer a wide variety of health plan designs, including copay, deductible, coinsurance, and tiered benefit structures. We also support custom plan designs that help employers encourage cost-effective healthcare decisions and align with their overall benefits strategy.
In addition, Pinnacle can administer and integrate with a broad range of ancillary benefits and programs, including wellness initiatives, disease management, pharmacy benefits, consumer-driven accounts (HSA, FSA, HRA), cost transparency tools, advocacy services, reporting and analytics, and other employer-selected benefit solutions.
Need help? Let’s get you to the right place.
Customer service
For questions about eligibility, claims, benefits, provider information, or general plan support.
Phone: (800) 649-9121
Email: [email protected]
Utilization management
For pre-authorization questions, future admissions, or current hospital admission notifications.
Phone: (800) 777-9428
Web OPIS support
For help accessing Web OPIS or setting up your provider account.
Phone: (833) 586-9733
Email: [email protected]
Provider Contracting and Relations
For Cedar Health Network participation, credentialing, practice updates, training requests, provider manuals, reference materials, or fee schedule questions.
Email: [email protected]
W-9 and provider information updates
For W-9 questions or provider information updates that need to be routed to Provider Relations.
Email: [email protected]
Need provider support?
For eligibility, benefits, claim status, pre-certification, Rx prior authorization, payment details, or contract questions, call our provider support line for the fastest path to the right information.
Call provider support: 1-800-649-9121
