Representatives in this department answer questions and resolve issues that providers may have regarding claims. Pacific Health MSO is committed to ensuring that helpful and competent representatives are available to answer questions and provide assistance. Additionally, QUICKCAP includes a customer service module where all issues and responses are documented.
Processing
The Claims Processing Department is responsible for timely routing and proper adjudication of all claims within the guidelines established for each line of business. The Department regularly establishes goals and standards for effective claims processing. Pacific Health MSO uses QuickCap to log, adjudicate and pay claims. The Claims Department is also responsible for ensuring all IPAs are in compliance with regulatory requirements and preparing for health plan audits.
Providers are encouraged to submit claims electronically through our internet portal. Paper claims are routed directly to our mailing address then the data is converted for electronic in loading. Approximately, 80% of all providers are currently submitting electronically. Remember beginning January 1, 2012 all claims must be submitted electronically.
Mission Community IPA Medical Group, Inc.
820 South Garfield Avenue Suite 201A Alhambra, CA 91801