If you suspect illegal or wrongful billing practices or other fraudulent activity, call our Fraud Hotline or send us an email: Blue Shield of California Promise Health Plan provides free aids and services to people with disabilities to communicate effectively with us and provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. Integrated Care for Dual Eligible Beneficiaries - DHCS SCFHP does not accept claims or provider disputes (PDR) via FAX. Why Choose L.A. Care? Please select one of the states in which we provide services. 2002-2023. The information below can assist you in submitting claims to the correct location, which will alleviate the need for SCFHP or our delegates to redirect a claim that was received at the incorrect location. Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Monday through Friday, 8:00 a.m. to 6:00 p.m. Cal MediConnect Provider Resources | L.A. Care Health Plan Health Net is working hard to make claims procedures easier for providers, both online and offline. A corrected claim is where you identified missing information or misinformation on your original claims submission that resulted in a payment different than what you expected to receive. Need More Information Regarding the 2022 Cal MediConnect Program? About Blue Shield of CA Promise Health Plan. The hub for these CareMore Health programs are the neighborhood care centers where our teams of Case: Patents/Claim Construction (C.D. Cal.) - Bloomberg Law News We at Blue Shield of California Promise Health Plan respect your privacy, and we work hard to protect the information you provide online. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. , We cover behavioral health and substance abuse services., Prescription drugs covered through Molina Dual Options can be found in the Drug List (Formulary)., Learn more about your Summary of Benefits, and read your Member Handbook, along with finding providers near you., We work with our providers to give you good health care.. Health and Human Services Agency. Getting Help | Cal MediConnect Contact Number; Health Net Provider Services Center (Except Medi-Cal and Medicare) 1-800-641-7761: Provider Services Medi-Cal: 1-800-675-6110 1-800-281-2999 (fax) Provider Services Cal MediConnect: Los Angeles County San Diego County: 1-855-464-3571 1-855-464-3572: Provider Services Medicare Advantage Plans: Green, Ruby, Healthy Heart I, Violet For more information contact the plan or read the Anthem Blue Cross Cal MediConnect Plan Member Handbook. Visit our Provider memos page for more details on claims and billing. PDF Medical Paper Claims Submission Rejections and Resolutions - Health Net SCFHP will investigate your dispute and issue a written resolution within 62 calendar days or 45 working days from the date the dispute is received. Primary payor COB information may be submitted electronically on HIPAA standard ASC X12N 837 (005010X222) Professional and ASC X12N 837 (005010X223) Institutional transactions. Providers must submit claims to the correct address using the appropriate entity name as identified below. Discrimination is against the law. A request for authorization must be made via telephone to Health Net's hospital Notification Unit at 1-800-995-7890 Option 1. CHDP, DME, hearing aids, home health, inpatient and outpatient facility, and injectables over $250 are non-delegated claims and are the responsibility of SCFHP. Help your patients with redetermination. You may find the information to identify a delegated provider agreement below by delegate: Kaiser Foundation Health PlanAttn: Claims Administration Dept.PO Box 12923Oakland, CA 94604-2923, Submit all non-delegated claims to SCFHP (see SCFHP claims billing). A new programto promote coordinated health care delivery for seniors and people with disabilities who are dually eligible for state Medi-Cal and the federal Medicare program are partnering to launch a three-year project. Blue Shield of California Los Angeles County 1-855-464-3571 TTY: 711 Hours are from 8 a.m. to 5 p.m., Monday through Friday. Effective May 18, 2020, most Medicare dual crossover claims will be submitted through a Coordination of Benefits Agreement (COBA) with the Centers for Medicare & Medicaid Services (CMS). P.O. Claims mailing addresses | Blue Shield of CA Provider The benefit information is a brief summary, not a complete description of benefits. Health Net Community Solutions, Inc. is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. See how we support the vision of everyone having fair and just opportunities to be as healthy as possible. Phone:(800) 541-6652 For that type of question, ourMember Portalhas a self-serve link for resetting your username or password. You are leaving this website to go to a website managed by a contracted company, which provides service on our behalf. Phone:(800) 662-5502 L.A. Care Medicare Plus coordinates Medicare and Medi-Cal benefits under one health plan to offer a network of doctors, hospitals and pharmacies that will provide your Medicare and Medi . Los Angeles County: 1-855-464-3571 (TTY: 711), 8:00 a.m. to 5:00 p.m.,Hours are from 8 a.m. to 5 p.m., Monday through Friday. APPLICATIONS. If you need further assistance, you can request a representative to contact you via the form below. Change Healthcare Claims Payer ID: 57115 (866) 371-9066 www.changehealthcare.com Get paid electronically Electronic funds transfer (EFT) allows you to have your claims payments deposited directly into your business account, minimizing your risk of lost checks or lockbox delays. Learn more about the data we collect or request your data be removed. Choosing Who Can See My Confidential Medical Information. Depending on the languages, the page layout may look strange from the original. 12900 Park Plaza Drive, Suite 150 Mailstop 6150 | Cerritos, CA 90703 Need More Information Regarding the 2022 Cal MediConnect Program? fm.formularynavigator.com,medicare.entrykeyid.com,member.membersecurelogin.com,mmp.healthnetcalifornia.com,healthnet.com,ifp.healthnetcalifornia.com,cahealthwellness.com,healthnet.entrykeyid.com, Coverage Determinations and Redeterminations for Drugs, Prior Authorization, Step Therapy and Quantity Limits, Medication Adherence and Quality Assurance. ATTENTION: On January 1, 2023, California's Molina Dual Options Cal MediConnect Plan (Medicare-Medicaid Plan) members will transition into Molina Medicare Complete Care Plus (HMO D-SNP). P.O. P.O. A copy of this disclaimer can also be found on our Disclaimer page. Max Length=35,special characters allowed ,'-. Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, pas de origen, ascedencial, religin, sexo, estado civil, genero, identidad de genero, orientacin sexual, edad ni discapacidad. 620 S. Dora St., Suite 201 WHAT THE CCI MEANS FOR YOU AND YOUR PATIENTS Blue Shield of California Promise Health Plan offers Medi-Cal. Welcome to the Santa Clara Family Health Plan (SCFHP) Provider Resources page for claims. View our FAQs. California Provider - Anthem Blue Cross Please refer to the provider memo: New billing process for Medicare crossover claims through COBA for additional information. Health Net is contracted with Medicare for HMO, HMO SNP and PPO plans, and with some state Medicaid programs. Box 272540 Professional and Supplier Claims Download the free version of Adobe Reader. 24/7 NurseLine Phone: 1-800-224-0336 TTY: 1-800-368-4424 Customer Care Center for Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Phone: 1-855-817-5786 Fax: 1-888-235-8468 Fresno/Madera: 1-559-353-3500 Please note that once you have left our website, you may be able to access portions of the contracted company's website that are not related to your plan. This one-stop shop for your role in California's Coordinated Care Initiative has information on Managed Long-Term Services & Supports, Behavioral Health, Balanced Billing, Continuity of Care and more. Step 5: Wait for a decision - The Medi-Cal office will look at your application and decide if you qualify for Medi-Cal. Submitting a Claim | L.A. Care Health Plan Phone:(800) 541-6652, (Subscriber ID number begins with the letter "R.") On January 1, 2023, all Cal MediConnect Plans (CMC) will become Medicare and Medi-Cal plans operated by the same company. If you need further assistance, you can request a representative to contact you via the form below. Apple and the Apple logo are trademarks of Apple Inc. App Store is a service mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. Your call will be returned within the next business day. Health Net is a registered service mark of Health Net, LLC. Contact Us | California Provider - Anthem Blue Cross Blue Shield of California Promise Health Plan, 601 Potrero Grande Drive, Monterey Park, CA 91755. Call Member Services at1-855-817-5785 (TTY: 711)Monday through Friday from 8 a.m. to 8 p.m. For questions about claims procedures, contact Provider Services. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Please consult with a translator for accuracy if you are relying on the translation or are using this site for official business. Learn more about the BlueCard Program. Community Health Group | San Diego County Health Plans for Medi-Cal and Submit a claim or dispute | Santa Clara Family Health Plan - SCFHP and Centene Corporation. Check subscriber ID for three-letter prefix before sending. Learn how to submit all of your claims and receive your payments electronically for faster processing and payment using electronic data interchange (EDI). Email: CallCenterManagement@scfhp.com DualConnect Customer Service If you have questions or need help, call: Phone: 1-877-723-4795 TTY: 711 Hours: 8 a.m. to 8 p.m., 7 days a week Box 272640 Choosing Who Can See My Confidential Medical Information. Choosing Who Can See My Confidential Medical Information. If you wish to stay on this website, please click Cancel. You will need Adobe Reader to open PDFs on this site.
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