Optionally, you can attach a formal letter below listing the persons you authorize to request this access. Box 371330. TRACKING NUMBER: PROVIDER ID#: a. 0000002476 00000 n 0000019660 00000 n 0000002033 00000 n 0000018941 00000 n *Provider Name: *Provider TIN: Provider Address: Provider Type: MD AddressNo.145, Zhengzhou Rd., Datong Dist., Taipei City 10341, Taiwan (R.O.C.) 0000039956 00000 n Process for Non-contracted Medicare Providers. To learn more about Optum, please . You have the responsibility to notify your health care provider if you notice any change in your health. m9*42*S$"#ru-.:,f/Z$iSqE9Qb=LnthnA,989j/9! Submit Provider Dispute Resolution form for each batch of similar issues iii. This webpage represents 1750455713 NPI record. You have the right to tell us if you're unhappy with any of your medical care or service. 0000038644 00000 n 0000020146 00000 n We're proud to tell you that Inland Faculty Medical Group has joined the Optum family and that our name has changed to Optum. +(f.t{ewK26IZ0ViqB0 QBz&V_`nyVX&k,jjZH8$14n^F'0 nD1CU R(}X7T\Y!Ol/Tx h PzH-Y"'hg*%F@2GCM4T&ZP"TJ2]%GVt7",=*clp%rB(9\,6 0 Guo[ro11M&V+S|#e8O$Bw `wi+|Nxr_eJ}nIa?z\^4{d9Wk^vaKT+[G{Kcx|yQTE/VtlM^Qzugz". Further, services will be provided in a non-discriminatory manner to all members, including those with limited English proficiency or reading skills, the sensory impaired, and those with diverse cultural or ethnic backgrounds. 325 157 D | If you are interested in becoming a contracted provider, please fax your curriculum vitae, letter of interest, NPI and W-9 to our contracting department at (626) 943-6373 or via email at Contracting.Dept@nmm.cc. 0000031184 00000 n A Site Visit will be conducted for all new practice and as appropriate to investigate patient complaints. To Become A Contracted Provider. 0000033621 00000 n 0000066857 00000 n You have the right to access services & information in an alternative format and in any language that is prevalent among Facey patients. 0000016632 00000 n 0000008375 00000 n 0000028508 00000 n INLAND FACULTY MEDICAL GROUP, INC. NPI is 1750455713. Success is essential to maintaining a healthcare system that is affordable for everyone. 0000049486 00000 n 0000023663 00000 n SourceTaipei City Fire Department. We provide this information required by AB 1455. Quality Management. You have the right to receive clear and complete information about your condition and care, including explanations of procedures, tests, treatments and alternatives (including risks and benefits), in order to give informed consent or refuse treatment. Patient complaints at Primary Care, OB/GYN, inpatient, residential, ambulatory facilities providing mental health/substance abuse services and new facilities or locations will be monitored continually, investigated and/or referred to the appropriate individual(s) responsible for resolving the issue at all practice sites. Claims. Vulnerable Sections 01. Facey's family of providers has distinguished itself by the guidance of ethical and conduct standards. Providers. 0000034821 00000 n To obtain a provider dispute form, please contact the Appeals Coordinator at (818) 654-3400. 0000046652 00000 n To register, religious groups must fill out an online tax form that describes the group's activities. 0000063633 00000 n 31 64 0000016907 00000 n ;F8-#qZ8()JN" P. O. inland faculty medical group provider dispute form. 0000061688 00000 n 0000013357 00000 n _ A signed Waiver of Liability form. 0 0000024100 00000 n 0000025761 00000 n 0000139641 00000 n Welcome to Optum. 0000004742 00000 n CONTRACTED PROVIDER: _____ YES _____ NO 0000096348 00000 n NIGHT'S BLACK AGENTSDIRECTOR'S HANDBOOKkenneth hite gareth ryder-hanrahanby and night's black agentsdirector's. In addition to general service concerns, they can assist with questions about claims, service authorizations, appointments, eligibility, benefits, resources and more. no deductible), no paperwork (i.e. You have the right to receive treatment that is appropriate and consistent with your medical needs. If you want to file a grievance, please use this form. 0000022645 00000 n date and include at a minimum: _ A statement indicating factual The physician should document that he or she has warned the patient of the consequences of failure to follow medical advice or adhere to recommended treatment plans, including failure to keep appointments. Facey Medical Foundation uses board certified consultants as necessary to assist in making medical necessity decisions. 0000021134 00000 n Browse insurance lists. "Cow's milk is not appropriate for young infants," she says. You must accept personal financial responsibility for any charges not covered by your insurance. MV Medical Management (MVMM) is a full-service management services organization that provides administrative, technical and professional support to Independent Practice Associations (IPAs). hYmo6+&@ i5@ITc5wHSlIAEG{m,f. 0000024701 00000 n 0000107662 00000 n Prospect Medical Systems. Learn more about becoming part of Facey's external provider workforce. UM evaluates medical necessity, medical appropriateness and efficient use of medical services, procedures and facilities, including specialty care, inpatient, outpatient, home care, skilled nursing services, ancillary services and pharmaceutical services. trailer The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality. 0000035050 00000 n 0000034936 00000 n 0000018131 00000 n Reseda, CA 91337. 0000096087 00000 n 0000062956 00000 n Our suite of standard and specialty tests can help provide answers to improve patient outcomes. 0000026202 00000 n 0000047323 00000 n 0000012292 00000 n 0000036201 00000 n 90630 MS: CA124-0157WWW.UHCONLINE.COM, Health Care Management for Medical Groups, Family Practice Medical Group of San Bernardino, https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Model-Waiver-of-Liability_Feb2019v508.zip. 0000138917 00000 n 0000029549 00000 n 0000008205 00000 n hV{Tgf&wHU@CE B-UF@R#H`EQ jTDH PPHP-USUgw~ $ >m@ PX[?3>Z`b%z~skm[r{iw.8J At the discretion of the provider, a letter may be sent to the patient outlining the expected behaviors and the timeframe to exhibit requested changes in behavior. This is called filing a grievance. 0000016420 00000 n PrimeCare Chino. 0000034293 00000 n It is the policy of Facey Medical Group that, based on HMO contractual language, a contracted physician may request that an HMO/PPO patient be removed from his or her care subject to the nature and severity of the event(s). 0000030786 00000 n xb```e``e`c` B@vM+00>gVE@qhFGGG:bG2?s -63x7fc Ai You have the right to be treated with respect, recognition of your dignity and right to privacy. Resources. 0000027234 00000 n Moreover, providers must inform Medi-Cal members that they have the freedom of choice in An appeal is defined as a request by the patient or provider to reconsider a service request decision. (appeal) of a Medicare Advantage plan payment denial determination including 0000003436 00000 n odt (10.83 KB) Fire Record Certificate. Co-pays are specific to the patients health plan benefits and the services rendered at the time the patient is seen. 0000046499 00000 n To appeal a claim denial, 0000040244 00000 n You have the responsibility to ask for clarification about any aspect of your care which you do not fully understand and to participate in developing mutually agreed upon treatment goals. P | 0000061763 00000 n 0000019142 00000 n Physicians may provide this notice by one of three methods: Quality Management is an all encompassing philosophy that supports our organizations management infrastructure, policies & procedures and practices. It is the responsibility of the provider of service to verify and collect the co-pay from the member at the time of service as the co-pay may differ from that stated on the authorization. 0000006568 00000 n Provider Relations (909) 890-2054. Prior to dismissing the patient from your practice, please contact the Facey Medical Foundation Quality Management Department for assistance with transferring the member to another specialist if continued care is required. We are managed by MV Medical Management (MVMM), a full-service management services organization. 0000032422 00000 n The 1750455713 NPI number is assigned to the healthcare provider OPTUM CARE NETWORK-INLAND FACULTY MG, practice location address at 952 S MOUNT VERNON AVE STE B COLTON, CA, 92324-4224. pU-EV$cJ8B-8x^9\y Nu3eC0#'} H=J;!2~7{(J# 0000007962 00000 n Regal Medical Group. You have the right to exercise your rights without being subjected to discrimination or reprisal. 0 If you would like to report any matter concerning privacy, billing, compliance or integrity, please use the anonymous Providence Integrity Line: 888-294-8455. Complete a provider dispute resolution request. 0000034985 00000 n If you wish to report a compliance issue directly to a health plan, please make use of the following numbers: The Department of Managed Health Care (DMHC) created regulations designed to improve timely access to care. %%EOF 0000040100 00000 n Filtered by: DPL-Footer Legal And Social Bar Component, Optum Care NetworkSouthwestern Valleys. 0000107401 00000 n 0000012825 00000 n E | For help finding a primary care or specialty care provider (doctor) accepted by your health insurance plan, please contact your health plan directly. submit a written request within 60 calendar days of the remittance notification You have the right to candid discussion of appropriate or medically necessary treatment options for your condition regardless of cost or benefit coverage. 0000005589 00000 n This discussion should also be documented in the medical record. 0000028988 00000 n 0000040415 00000 n The patient will be verbally counseled by the provider when he/she does not follow medical advice or treatment plans. zMuI0)p/>R g?r VXhE:*{pYnk9(0m} TrfL7MKLWEKJ!n6. mbc.ca.gov. (i . To confirm eligibility, contact the health plan directly: In 2001, Facey Medical Group implemented its electronic health record (EHR) system, making it one of the earliest adopters of this technology and one of the few physician groups in Southern California to have such a system. Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression, and other topics related to women's health. 0000023834 00000 n For more information, call (866) 654-3471 and request Network Management. B | Eligibility. x For routine follow-up regarding claims status, please contact the CalOptima Claims Provider Line: 714-246-8885. x Mail the completed form to: CalOptima Claims Provider Dispute. Should you have any questions, please email providerinfo@prospectmedical.com or, contact our Provider Relations department at (800) 708-3230, option 1 then 7. Facey Medical Group is a large, dynamic and well established multi-specialty medical group with more than 180 physicians providing care to the growing population in the North & East regions of Los Angeles and Ventura counties. Resubmission: 365 Days from date of Explanation of Benefits. Customer Service Department Phone Number: 858-499-2550 Toll Free Phone Number: 1-877-518-7264 TDD/TTY: 711 Fax Number: 858-636-2038. 0000074452 00000 n Non-Profit Company, PO Box 235 0 0000043792 00000 n 0000021920 00000 n 27Q~h Xe You have the right to receive a timely response to any reasonable service request. LaSalle PharMedQuest Treatment Request Forms- All 9. You have the right to voice complaints or appeals about Facey Medical Group or the care provided. 0000012550 00000 n The government uses this form to determine the group's tax status. As a major provider of education and training, ICS sets and examines the syllabus for membership, providing the shipping industry with highly qualified professionals. If you are interested in working with Facey as an contracted, external provider, please send us a letter of interest and a copy of your CV. Box 989881. For the patient, an HMO means reduced out-of-pocket costs (i.e. We hope that you have found the information about Vantage Medical Group Provider Dispute Resolution Form that interests you. You have the right to be represented by parents, guardians, family members or other conservators if you are unable to fully participate in your treatment decisions. 0000047615 00000 n A contracted provider dispute is a providers written notice to Facey Medical Foundation challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially-similar multiple claims that are individually numbered) that has been denied, adjusted or contested, or seeking resolution of a billing determination of other contract dispute (or bundled group of substantially-similar multiple billing or other contractual disputes that are individually numbered), or disputing a request for reimbursement of an overpayment of a claim. To submit a formal appeal, please see the instructions listed on the back of your explanation of payment (EOP). If you are interested in working with Facey as an contracted, external provider, please send us a letter of interest and a copy of your CV. {Y*/sJ(Czw skR6VPf>QrG h \PsuA#CN=irD 82$jh4YSU! We take great pride in the care we provide, which is why we are seeking those who are dedicated to our vision of conscientious, quality care and development of strong practice goals. Send by fax: 818-837-5787. It is the policy of Facey Medical Group and Facey Medical Foundation to adhere to the access standards established by the Industry Collaboration Effort (ICE), the Health Plans and the Department of Managed Health Care (DMHC) Time-elapsed Access Regulations. Potential quality issues and deviant medical practice identified by UM staff are reported to the Quality Management Department for review and action as necessary. The law prohibits religious instruction in public . J,CS d0hWe[YwAYXJWzL|csjn#$x4J .$^^h uX6ftqPO"]:Tbx2Il#/N&8(y0 wXh;dFovaliLox{` 29 Learn more about becoming part of Facey's external provider workforce, Integrity and Compliance Program In Partnership with Our Vendors, Conflict of Interest, Fraud Abuse & Self Referral Policy, Download Anthem's 2015 Medicare Advantage and Part D General Compliance Training, Facey Policy - Provider Appointment Access Standards, Memo to Providers - DMHC Timely Access Regulations, Notice of Nondiscrimination and Communication Assistance, Summary of the Code of Conduct Administrative Policy, Facey Medical Foundation Code of Conduct and Compliance Plan, WellPoint Standards of Ethical Business Conduct: a part of WellPoints fraud, waste and abuse training program. 0000009553 00000 n Such complaints regarding the clinical care of patients by physicians will be shared in a confidential manner with the individual physician involved and the respective Department Chair. 0000014061 00000 n (EPMG) Inland Faculty Medical Group (IFMG) Riverside Physician Network; DPL Utility Nav Items. 325 0 obj <> endobj %PDF-1.5 % Medi-Cal. San Bernardino County, High Desert Radiology Authorization Request Form. hbbd```b`` Do,`L~ Lm`|J0LFIF{`N'kHc.aNg`z~ INLAND FACULTY MEDICAL GROUP, INC. NPI is 1750455713. 0000009204 00000 n Tutorial. You have the right to be free from all forms of abuse or harassment. Appeals will be reviewed by the Medical Director of Quality Management and a response to the health plan will be formulated based on chart review, health plan benefit interpretation and criteria as well as any additional information from the provider(s) on an as-needed basis. A form of health insurance in which its members prepay a . Find helpful forms you may need. All network providers are required to review and attest annually to completing the trainings using the 2022 Annual Provider Training Attestation Form. About us. 0000026696 00000 n In accordance with the Network Medical Management group policy, all providers, vendors, and contractors are prohibited from contracting with Excluded Parties. 0000002985 00000 n Initial Claims: 180 Days. All medical records requested by the HMO will be sent out according to the health plans specified timeframes for Routine, Urgent and Expedited. Optum Care Network-Corona. 0000033705 00000 n 0000028783 00000 n Mail the completed form to: Nivano Physicians PO Box 869140, Plano, TX 75086 DISPUTE TYPE Claim Seeking Resolution Of A Billing Determination Appeal of Medical Necessity / Utilization Management Decision Contract Dispute notice showing the claim denial, _ Any additional information, We look forward to collaborating! 0000032257 00000 n 33 Hospitals in Riverside and San Bernardino Counties Hemet Valley Medical Center trailer 0000088529 00000 n Quality Management is driven by five basic principles: As defined, Quality Management embraces features of both Quality Assurance and Quality Improvement and goes one step further to embody our management philosophy. All states: Use the most updated MA and commercial Monthly Timeliness Report (MTR) you received from the Claims Delegation Oversight Department. . The Medical Director of Quality Management, as appropriate, will forward the complaint and the physician response to the Peer Review Committee. Nat'l SVP, Network Management & MSO Operations. clinical records or documentation. 0000005274 00000 n or legal basis for appeal. 0000026031 00000 n 0000006698 00000 n These regulations establish the minimum compliance standards for enrollee accessibility to primary, specialist, behavioral health, and ancillary care providers. 0000024962 00000 n Welcome to the Northern Ireland Assembly web site, which was set up to inform interested viewers of the day-to-day business and historical background of devolved Government in Northern Ireland. 0000096558 00000 n 0000006952 00000 n Multiple "LIKE" claims are for the same provider and dispute but different members and dates of service. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. You have the responsibility to follow the agreed upon plans and instructions for your care. All complaints and appeals received from the HMOs will require a formal written response and medical record request within the time period specified by the HMO, depending on the urgency. 94 0 obj <>stream Claims Department Q | Inland Empire Health Plan (IEHP) has over 1,241 Doctors, 3,698 Specialists, 724 Pharmacies, 74 Urgent Care, 242 OB/GYNs, 382 Behavioral Health Providers, 39 major Hospitals . 117 0 obj <>stream LaSalle Provider Policy Manual - July 2015. The concern may reach the Medical Group directly from the patient or via the health plan. 0000027466 00000 n Network Medical Management (NMM) is committed to conducting its business operations with the highest ethical standards and in full compliance with healthcare industry standards and regulations and all applicable Federal and State laws. General Studies Paper-1 1. Get claims and resolution contact information (for example, address). Get claims and resolution contact information (for example, address). IPA/Medical Groups Heritage Provider Network Affiliated Doctors of OC . The information must read as follows. Mercy Physicians Medical Group (MPMG) Optum, formerly Primary Care Associates (PCA) Optum, formerly Valley Physicians Network (VPN) Optum, formerly Empire Physicians Medical Group (EPMG) Optum, formerly Inland Faculty Medical Group (IFMG) Riverside Physician Network The NPI is a 10-digit identification number that is completely unique. For more information, see also the related pages. Provide additional information to support the description of dispute. Provide additional information to support the description of the dispute. 0000038200 00000 n The provider's authorized official is Martha Knowlton . The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model. 0000009685 00000 n Pursuant to federal regulations governing the Medicare Our goal is to make hardworking, clinically strong physicians shareholders in order to secure the long term strength of the organization. Our Work. 0000031019 00000 n 0000001932 00000 n A patient complaint is defined as any concern voiced by a patient that cannot be resolved directly by the physician or staff interacting with the patient. For routine follow-up, please use the Claims Follow-Up Form instead of the Provider Dispute Resolution Form. 0000024271 00000 n 0000135164 00000 n 0000030615 00000 n 0000063308 00000 n Users experiencing any issues with this process are advised to contact the CORE Provider Portal Support team via email at portalsupport@agilonhealth.com or give us a call . 0000018670 00000 n 0000133580 00000 n INLAND FACULTY MEDICAL GROUP, INC. is a health maintenance organization in Colton, CA. Box 10369 San Bernardino, CA 92423 C. Time Period for Submission of Provider Disputes. 0000008787 00000 n It operates its own distance learning programme, TutorShip, and runs a variety of courses designed for both new entrants to the shipping industry and more experienced people . La Ex Important Committee - Read online for free. Send your CV and letter by email. The enumeration date for this NPI number is 11/20/2006 and was last updated on 8/22/2020. 0000012944 00000 n We provide quality health care for you and your family, at every stage of life. endstream endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <> endobj 48 0 obj <> endobj 49 0 obj <>stream You have the right to receive information about Facey Medical Group, its services, practitioners and providers, and members' rights and responsibilities. 0000049331 00000 n endstream endobj 60 0 obj <> endobj 61 0 obj <>/MediaBox[0 0 612 792]/Parent 57 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/Tabs/S/Type/Page>> endobj 62 0 obj <>stream Dispute form. 0000028273 00000 n Whether you are a current provider for Facey or considering a career with us, we encourage you to carefully review the standards laid out by the DMHC, as represented in the following downloadable documents: For more than 95 years, Facey Medical Group has been providing health care to families in the San Fernando, Santa Clarita and Simi valleys. The NPI number by itself does not contain any identifiable information such as a providers speciality or location. x Provide additional information to support the description of the dispute. 0000015916 00000 n Medical Records. issues related to bundling or downcoding of services. Authorized services may require a co-pay. 0000063943 00000 n 0000016117 00000 n Copyright 2010 - 2017 LaSalle Medical Associates, Forms and Other Resources for LaSalle Providers, LaSalle PharMedQuest Treatment Request Forms- All 9, LaSalle Provider Policy Manual July 2015, San Bernardino County, High Desert Radiology Request Procedures, San Bernardino County, High Desert Radiology Authorization Request Form, San Bernardino County, Metro San Bernardino Radiology Request Procedures, San Bernardino County, Metro San Bernardino Radiology Authorization Request Form, San Bernardino County, Metro San Bernardino direct Referral Form Temporary, Riverside County, Radiology Request Procedures, Riverside County, Radiology Authorization Form, Inland Empire Radiology List of Codes Requiring Authorization or Direct Referral, Inland Empire Radiology List of Maximum Patient Body Weight Exam Tables will Support, Los Angeles Medical Service Authorization form, Central Valley Medical Service Authorization form, Inland Empire Medical Service Authorization form, Web Portal for Authorizations, Claims and Eligibility, Auth, Claims and Eligibility Web Portal Users Guide. Lr+|(T+# EabHrN ~>1V4tqq[;4TN Appeals: 60 days from date of denial. 77 0 obj <>/Filter/FlateDecode/ID[<5E60C4266B99CE40974D16974734B99C><32E478B5AB116846AE7C959DB61CA030>]/Index[59 59]/Info 58 0 R/Length 96/Prev 382423/Root 60 0 R/Size 118/Type/XRef/W[1 3 1]>>stream Inquiries regarding claims, including receipts, status, payment and submission of electronic claims, may be made by contacting Facey's Customer Relations team; call 855-359-6323 or send by mail to the address above. box 1800 rancho cucamonga, ca 91729-1800 inter-valley health plan po box 6002 pomona, ca 91769 attn: provider appeals scan health plan po box 22698 long beach, ca 90801 united healthcare po box 6106 cypress . LaSalle Medical Associates is one of the largest Independent Practice Association groups in the San Bernardino, Riverside & Los Angeles counties. dXiPQ`dKYo23clX}L1:WsUyI9 gmk (0aQq-3&&d-@_L`[#OHf0u|9* 0000009034 00000 n ;=Ouvw"p.}@D3v ={ 0000036837 00000 n MVMM offers administrative, technical and professional support to independent practice associations. The payment record number is #745049815. 0000049401 00000 n 0000062983 00000 n You have the responsibility to inform your provider about any living will, medical power of attorney or other directive that could affect your care. startxref MTR forms, both monthly and quarterly reports, are due by the 15th of each month or the following business day if the due date falls on a weekend or holiday. 0000010480 00000 n 0000011965 00000 n Health Net Medi-Cal Appeals. &[c+\7qs\"NIl(t7ug5w_uRK=v:OR#(onAfF1O2zSnV-epMkVwkmOj^S9ux4l~62|s~ If you have any questions or concerns, please contact our Compliance Department via phone, fax, email, or mail. 0000010495 00000 n F | 0000027741 00000 n 0000063606 00000 n These types of complaints will be forwarded as appropriate to the designated health plans as indicated by ICE guidelines. 0000139353 00000 n If a person other than a beneficiary is requesting for a Direct Member Reimbursement, please download and fill out the Appointment of Representative Form. Submit the completed form along with the request for reimbursement and any pertinent documentation in order to complete the request to: Epic Management LPAttn: Claims Department1615 Orange Tree LaneRedlands, CA 92374, CLAIMS APPEALS - LISTING OF MEDICARE HEALTH PLAN APPEAL/PROVIDER DISPUTE ADDRESSES, Attention Non-contracted Medicare Providers, Appeals We do this for our affiliated entity PrimeCare Medical Network Inc. (PMNI or PrimeCare) and as the Management Services Organization (MSO) for the physician organizations listed below. PO Box 9605 These rights will apply to them as well. If you need to obtain a copy of a specific policy, please contact our Provider Services Department from Monday to Friday between 9:00 AM and 5:00 PM PST at (626) 943-6100. fwacompliance@networkmedicalmanagement.com. Data update2022-08-16 09:09. Review Date2022-08-16 09:09. Health (4 days ago) WebWelcome to Optum. You may choose to include your own log for multiple issues, but it must contain all . Box 57015 Facey Medical Group and Facey Medical Foundation conduct diligent internal processes and audits that review physician and allied health professional provider credentials, medical records, compliance with privacy laws, administration, quality management programs, continuity of care, diagnostic training, medication management, facility and environmental safety and surgical procedures. hb```!b`f`s The structured site review evaluates the following: Physician quality of care issues will be forwarded to Quality Management for investigation by the Medical Director of Quality Management or his designee. Please review the following: Effective June 27, 2010, a new regulation, mandated by Business and Professions Code section 138, went into effect requiring physicians in California to inform their patients that they are licensed by the Medical Board of California, and include the board's contact information. 0000013030 00000 n 0000014648 00000 n 0000003115 00000 n 120 Days. 0000031451 00000 n Sharp Community Medical Group 8695 Spectrum Center Blvd., 4th Floor San Diego, CA 92123. Criteria are applied with consideration for the individual patients needs, which include but may not be limited to: age, co-morbidity, complications, progress of treatment, psychosocial situation and/or home environment. 0000009763 00000 n Criteria for appropriateness of medical services are clearly documented and available upon request. If you are currently an Optum patient, you may also call us at 1-877-267-8861 for help finding an Optum provider or location near you. The Centers for Medicare & Medicaid Services (CMS) requires that organizations like Facey provide prevention training to employees who administer or deliver Medicare benefits or services. BOX 14010ORANGE, CA 92863-9936BLUE SHIELD 65BLUE SHIELD 65 PLUS HMOPO BOX 9276300 CANOGA AVENUEWOODLAND HILLS, CA 91365-9856BLUE CROSS SENIORGRIEVANCES AND APPEALSOH0205-A537 MAIL LOCATION4361 IRWIN SIMPSON RD. . Practitioners and individuals who conduct utilization review are not rewarded for denials of coverage or service care and there . X | We believe that you, as our patient, have certain rights: We also believe that you, as our patient, have certain responsibilities when receiving care from Facey Medical Group: This section addresses Facey Utilization Management (UM) processes and the integration of Facey Case Management (CM) services for our Managed Care patients. This applies to all DMHC licensed health care service plan contracted practitioners (e.g. 1-877-282-8272 1668 South Garfield Ave., 2nd Fl, Alhambra, CA 91801 0000003838 00000 n YOU ARE REQUIRED TO SUBMIT A WAIVER OF LIABILITY FORM FOR ALL RECONSIDERATION/APPEALS. 0000022953 00000 n 0000064164 00000 n 0000010646 00000 n Results of the QM review and any trends identified are reported to the Peer Review Committee and sent to the QM committee on an annual basis. The authorized official title is Provider Relations Manager and has the following contact phone number (909) 433-9111. 8,C4? W%H3# C 0000134309 00000 n The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552.