How to submit a application

HOW TO SUBMIT NEW APPLICATIONS

Congratulations on successfully enrolling a new patient!

To submit  applications please fax or drop off the application within 24 hours of the enrollment.

CISA

14541 BROOKHURST ST SUITE A5-A7
WESTMINSTER CA 92683

FAX: 1-866-515-8850

Applications must be sent from 9 am to 5pm Monday through Friday. If you are sending applications before 9 am or after 5 pm or on the weekends, you must fax it directly to the health plans and SEND US A COPY. See the fax numbers below for the appropriate carriers.

IT’S IMPORTANT TO
REVIEW ALL THE INFORMATION ON YOUR APPLICATIONS BEFORE SUBMITTING!

 


Health Plan
Preferred Method to submit app Fax Number
Easy Choice Fax 866-473-9124
WellCare MA-PD/PDP Fax 866-473-9124
WellCare PDP only Fax 866-388-1521
Health Net Fax 800-845-7429
Scan Fax 562-989-5243
UnitedHealthCare MAPD Fax 501-262-7070
UnitedHealthCare PDP Fax 866-994-9659
UnitedHealthCare Supplement Fax 888-836-3985
Care1st Fax 323-889-5402
Central Health Fax 626-388-2371
Brand New Day Fax 657-400-1207
Blue Shield MAPD & PDP Fax 877-251-3660
Blue Shield Supplement Fax 844-266-1850