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 |