L.A. CARE SR L.A. CARE SR L.A. CARE SR L.A. CARE SR L.A ...

KEY:

HK: Healthy Kids

MCLA: Medi-Cal

COMM: CHP Transitioned Members

PS: PASC-SEIU (Formerly IHSS)

LAC: L.A. Care Covered (Covered CA Exchange Product)

LACD: L.A. Care Covered Direct

CMC: Cal MediConnect

SR: Shared Risk Contract FR: Full Risk Contract DR: Dual Risk Contract

General Overview; For specific questions regarding

contracted sevices, authorizations,

or DOFR's, please reach out to the PPG/MSO at phone

number provided.

Regio

n

Codes

Participating Provider Group

Management Company (MSO)

Phone

For All Lines of Business: Professional Authorizations and Payments are responsibility of PPG

See chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of

business

Delegation

Status

HK

AHF

AKM

AIDS HealthCare Foundation

AKM Medical Group

888-238-7463

Conifer Health Solutions

818/461-5000

Standard

Standard

Please note for Sub Acute and Skilled Nursing Facilities, please refer to the SNF Auth/Billing Reference Guide.

Lines of Business

LAC &

LACD

MCLA COMM PS

SR

CMC Non

Institutional

Aid

CMC

Institutional

SR

AUTHORIZATIONS

PAYOR

PAYOR CLAIMS ADDRESS

PAYOR CLAIMS PHONE #

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Garfield Medical Center

L.A. CARE

Member's Capitated Hospital =

Alhambra Hospital Medical Center

(Claims with dates of service prior to

06/01/15, should be billed to L.A. Care)

Member's Capitated Hospital =

Alhambra Hospital Medical Center

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Citrus Valley Health Partners

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

AHMC Monterey Park Hospital

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Hollywood Presbyterian Medical Center

Member's Capitated Hospital =

Citrus Valley Health Partners

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

525 North Garfield Avenue Monterey Park, CA

P.O. Box 811580 91754

Los Angeles, CA 90081

(626)573-5324

(888)4LA-Care(452-2273)

100 South Raymond Ave Alhambra, CA 91801

(626) 570-1606

101 South Raymond Ave Alhambra, CA 91801

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

PO Box 840147

Los Angeles, CA 90084-0147

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(626) 570-1607

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

900 S. Atlantic Blvd. Monterey Park, CA 91754

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90082

(626)570-9000

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

PO Box 3100-1041 Pasadena CA 91110

PO Box 840147

Los Angeles, CA 90084-0147

(323) 953-2657

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

531 West College Street Los Angeles, CA 90012

8510 Balboa Blvd Ste 285, Northridge, CA 91325

(213) 624-8411

(818)654-3400

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

L.A. CARE

Member's Capitated Hospital= St.

Francis Medical

Center

L.A.

CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital= St.

Francis Medical

Center

L.A.

CARE

L.A. CARE

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

PO Box 6028 Artesia CA 90702

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(714)443-4500

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

PO Box 6028 Artesia CA 90702

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90082

P.O. Box 811580 Los Angeles, CA 90081

(714)443-4500

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

L.A. CARE

SR

SR

SR

DR

SR

AP

Allied Physicians IPA

Network Medical Management

(626)943-6251

Extended

PPG

DR

DR

SR

SR

APCV

Citrus Valley Independent Physicians (subsidary of Allied)

Network Medical Management

626/282-0288

SR

Extended

PPG

DR

SR

SR

AMHS

DR

AMMP

AltaMed Health Services Corporation

866/880-7805

SR

Extended

PPG

SR

AMHP

DR

AMCV

DR

L.A. CARE

L.A. CARE

SR

AIPA

Angeles IPA

Synermed

213/406-2600

Extended

AVMA

Antelope Valley Medical Assoicates, Inc.

Heritage Provider Network

818-654-3400

Standard

SR

PPG

PPG

DR

AVHC

Antelope Valley Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

FR

Health Integrated

SR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA. Care

Standard

SR

DR

SR

AMGS

Apple Care Medical Group, St. Francis, Inc

AppleCare Medical Management

800/460-5051

Extended

PPG

DR

SR

SR

SR

APPL

Apple Care Medical Group, Inc. Select Region, Downey and

Whittier

AppleCare Medical Management

800/460-5051

Extended

PPG

DR

SR

AMGW

8

Apple Care Medical Group, Inc Whittier Region

AppleCare Medical Management

800/460-5051

Extended

SR

SR

PPG

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Pacific Alliance Medical Center

PPG

L.A. CARE

PPG (Professional & Facility)

(626)814-2504

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(626)814-2504

(800) 832-6334, option 2

Regio

n

Codes

Participating Provider Group

Management Company (MSO)

Phone

For All Lines of Business: Professional Authorizations and Payments are responsibility of PPG

See chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of

business

Delegation Status

HK

AXMG

BHC

Axminster Medical Group

Bellflower Health Center

310/675-5370

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Lines of Business

LAC &

PS

LACD

MCLA COMM

SR

Extended

CMC Non

Institutional

Aid

SR

CMC

Institutional

AUTHORIZATIONS

PAYOR

PAYOR CLAIMS ADDRESS

PAYOR CLAIMS PHONE #

PPG

L.A. CARE

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

L.A. CARE

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Citrus Valley Health Partners

L.A. CARE

Member's Capitated Hospital =

Pacific Alliance Medical Center

Member's Capitated Hospital =

Valley Presbyterian Medical Center

Member's Capitated Hospital =

Pacific Alliance Medical Center

Member's Capitated Hospital =

Valley Presbyterian Medical Center

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Pacific Alliance Medical Center

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

PO Box 840147

Los Angeles, CA 90084-0147

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

531 West College Street Los Angeles, CA 90012

Conifer Health Solutions P.O. Box 260890 Encino,

CA

91426

531 West College Street Los Angeles, CA 90012

Conifer Health Solutions P.O. Box 260890 Encino,

CA

P.O. Box 811580 91426

Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(213) 624-8411

(818)461-5055

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

531 West College Street Los Angeles, CA 90012

(213) 624-8411

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

PPG (Professional & Facility)

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

SR

BVMG

Bella Vista IPA

MedPOINT Management

818/702-0100

Extended

310/423-3277

Extended

SR

PPG

SR

SR

CSMA/

CSMG

Cedars Sinai Medical Foundation and Cedars Sinai Medical

Group

SR

PPG

SR

SR

CVPG

Citrus Valley Physician Group

MSO Coast Healthcare Management,

Inc.

562/602-1563

Extended

PPG

SR

DR

SR

DR

CFC

Community Family Care

Conifer Health Solutions

818/461-5000

DR

Extended

PPG

DR

CFCV

DR

SR

CFCA

Community Family Care - Antelope Valley

Conifer Health Solutions

818/461-5000

SR

Extended

PPG

SR

L.A. CARE

SR

CRCM

Crown City Medical Group

Synermed

213/406-2600

Extended

DR

Dollarhide Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

DHHC

PPG

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

SR

EPDB

El Proyecto Del Barrio, Inc.

MedPOINT Management

818/702-0100

Extended

SR

PPG

SR

SR

EMCH

El Monte Comprehensive Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

DR

Standard

DR

ERCH

Edward R Roybal Comprehensive Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

DR

8

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

PPG (Professional & Facility)

L.A. CARE

PPG (Professional & Facility)

Lower Level of Care: LA Care

L.A. CARE

PPG (Professional & Facility)

Lower Level of Care: LA Care

(800)832-6334

(888)4LA-Care(452-2273)

(626)814-2504

(888)4LA-Care(452-2273)

(818)461-5055

(213) 624-8411

(800)832-6334

(800)832-6334

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(800)832-6334

Regio

n

Codes

Participating Provider Group

Management Company (MSO)

Phone

For All Lines of Business: Professional Authorizations and Payments are responsibility of PPG

See chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of

business

Delegation Status

HK

Lines of Business

LAC &

PS

LACD

MCLA COMM

SR

EHSG

Employee Health Systems

Synermed

213/406-2600

Extended

ECMG

Exceptional Care Medical Group

Conifer Health Solutions

818/461-5000

Standard

CMC Non

Institutional

Aid

CMC

Institutional

SR

AUTHORIZATIONS

PAYOR

PAYOR CLAIMS ADDRESS

PAYOR CLAIMS PHONE #

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

Pacific Alliance Medical Center

L.A. CARE

L.A. CARE

L.A. CARE

Member's Capitated Hospital =

White Memorial Medical Center

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

531 West College Street Los Angeles, CA 90012

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(213) 624-8411

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

1720 East Cesar Chavez Avenue Los Angeles, CA

90033

P.O. Box 811580 Los

Angeles, CA 90081

(323) 265-5085

(888)4LA-Care(452-2273)

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

PPG

SR

L.A. CARE

SR

SR

SR

FCS

Family Care Specialists IPA, A Medical Group Inc.

Coast Healthcare Management, LLC

562/602-1563

Standard

L.A. CARE

DR

SR

GPHC

Glendale Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

SR

SR

GCMG

Global Care IPA

MedPOINT Management

818/702-0100

DR

Extended

PPG

DR

SR

SR

SR

SR

DR

HCLA

Health Care LA, IPA

MedPOINT Management

818/702-0100

Extended

PPG

DR

DR

SR

HESS

Health Essentials

714/619-8777

Standard

HCPM

Healthcare Partners

310/793-5412

Extended

SR

SR

L.A. CARE

SR

SR

PPG

SR

SR

HD

HCHC

HDHS

8

High Desert Medical Group

H Claude Hudson Comprehensive Health Center

High Desert Multi-Service Ambulatory Care Center

Heritage Provider Network

DHS- Managed Care Services

DHS- Managed Care Services

661/945-5984

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

L.A. CARE

PPG (Professional & Facility)

FR

Extended

FR

PPG

Lower Level of Care: LA Care

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

Member's Capitated Hospital =

California Hospital Medical Center

1401 South Grand Avenue Los Angeles, CA

90015

Member's Capitated Hospital =

Hollywood Presbyterian Medical Center

PO Box 3100-1041 Pasadena CA 91110

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

Member's Capitated Hospital =

California Hospital Medical Center

1401 South Grand Avenue Los Angeles, CA

90015

Member's Capitated Hospital =

Hollywood Presbyterian Medical Center

PO Box 3100-1041 Pasadena CA 91110

Member's Capitated Hospital =

Conifer Health Solutions P.O. Box 260890 Encino,

CA

Valley Presbyterian Medical Center

L.A. CARE

P.O. Box 811580 91426

Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

PPG

43839 N 15th Street West Lancaster, CA 93534

PPG

43840 N 15th Street West Lancaster, CA 93534

(800)832-6334

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(213) 748-2411

(323) 953-2657

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(213) 748-2411

(323) 953-2657

(818)461-5055

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(661)944-5-5984

(661)944-5-5985

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

Standard

DR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

Health Integrated

SR

Standard

PPG (Professional & Facility)

PPG (Professional & Facility)

Lower Level of Care: LA Care

(800)832-6334

(800) 832-6334, option 2

Regio

n

Codes

Participating Provider Group

Management Company (MSO)

Phone

For All Lines of Business: Professional Authorizations and Payments are responsibility of PPG

See chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of

business

Delegation Status

HK

HHHC

Hubert H Humphrey Comprehensive Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Lines of Business

LAC &

PS

LACD

MCLA COMM

CMC Non

Institutional

Aid

DR

Standard

CMC

Institutional

AUTHORIZATIONS

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

PAYOR

PAYOR CLAIMS ADDRESS

PAYOR CLAIMS PHONE #

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

PPG

PPG

P.O.Box 371390 Reseda, CA 91337

P.O.Box 371390 Reseda, CA 91338

(213)355-8988

(213)355-8989

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

PPG (Professional & Facility)

(800)832-6334

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

HUMC

Harbor/UCLA Medical Center (hospital-based clinic)

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

DR

PPG (Professional & Facility)

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

HUMF

Harbor/UCLA Family Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

LAKE

Lakeside Medical Group

Heritage Provider Network

(213) 355-8988

FR

Extended

FR

PPG

PPG (Professional & Facility)

(800)832-6334

(800)832-6334

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

LACU

LAC+USC Medical Center (hospital-based clinic)

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

DR

Standard

PPG (Professional & Facility)

DR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

(800)832-6334

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

LBCH

Long Beach Comprehensive Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

DR

Standard

PPG (Professional & Facility)

DR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

(800)832-6334

Health Integrated

LCC

8

Little Rock Community Clinic

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

SR

Standard

PPG (Professional & Facility)

Lower Level of Care: LA Care

(800) 832-6334, option 2

Regio

n

Codes

Participating Provider Group

Management Company (MSO)

Phone

For All Lines of Business: Professional Authorizations and Payments are responsibility of PPG

See chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of

business

Delegation Status

HK

Lines of Business

LAC &

PS

LACD

MCLA COMM

CMC Non

Institutional

Aid

LLAC

Lake Los Angeles Community Clinic

DHS- Managed Care Services

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

LPHC

La Puente Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

MLKH

Martin Luther King Jr. Multi-Service Ambulatory Care Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations: LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

OVMV

Mid-Valley Comprehensive Health Center

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

Inpatient Authorizations: LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

Olive View/UCLA Medical Center (hospital-based clinic)

DHS- Managed Care Services

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

Inpatient Authorizations : LA Care

Lower Level Of Care: Health

Integrated

DR

Standard

In-and out of Network (within L.A.

County) Authorizations: DHS

Out of Area (outside L.A. County):

LA.

Care

DR

SR

OMNI

Omnicare Medical Group

Conifer Health Solutions

818/461-5000

DR

Extended

PPG

SR

DR

SR

PH

Physicians Healthways

Central Health MSO

(877)431-2273

DR

Extended

PPG

SR

SR

PPN

PVMG

8

Pioneer Provider Network, A Medical Group, Inc.

Pomona Valley Medical Group

Med 3000/MedPOINT Management

Prospect Medical Systems/ ProMed

Health

Network

818/702-0100

Extended

909/932-1045

Extended

PAYOR

PAYOR CLAIMS ADDRESS

PAYOR CLAIMS PHONE #

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

1000 South Fremont Ave. Bldg A9-East, 2nd

Floor, Unit #4, Alhambra, CA 91803885

(888)4LA-Care(452-2273)

Lower Level of Care: LA Care

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

L.A. CARE

Member's Capitaed Hospital= St.

Francis Medical

L.A.

CARE

Center

Member's Capitaed Hospital= St.

Francis Medical

L.A.

CARE

Center

Member's Capitated Hospital =

Garfield Medical Center

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

L.A. CARE

P.O. Box 811580 Los Angeles, CA 90081

(888)4LA-Care(452-2273)

PO Box 6028 Artesia CA 90702

P.O. Box 811580 Los Angeles, CA 90081

(714)443-4500

(888)4LA-Care(452-2273)

PO Box 6028 Artesia CA 90702

P.O. Box 811580 Los Angeles, CA 90081

(714)443-4500

(888)4LA-Care(452-2273)

525 North Garfield Avenue Monterey Park, CA

P.O. Box 811580 91754

Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90082

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

P.O. Box 811580 Los Angeles, CA 90081

(626)573-5324

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

(888)4LA-Care(452-2273)

PPG (Professional & Facility)

PPG (Professional & Facility)

PPG (Professional & Facility)

PPG (Professional & Facility)

DR

OVMC

AUTHORIZATIONS

Health Integrated

SR

(800) 832-6334, option

1

Health Integrated

Tel. (888) 614-0565

fax: (887) 872-3161

CMC

Institutional

SR

SR

SR

SR

PPG

PPG

PPG (Professional & Facility)

(800) 832-6334, option 2

(800)832-6334

(800)832-6334

(800)832-6334

(800)832-6334

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