Greetings, Cal Care IPA members, and providers!
As of August 1, 2020, Cal Care IPA will be joining the Prospect Medical Group family of independent practices.
For members: If you have received information from your health plan and have questions, you can contact our Prospect Medical Group Member Services at MemberServices@prospectmedical.com or call 800-708-3230 and select option 2. We are happy to help answer any concerns.
For Providers: Please visit our website at https://www.prospectmedical.com/providers or contact us at ProviderInfo@prospectmedical.com or call 800-708-3230 and select option 1 then option 7.
All claims/encounters and referrals with dates of service, August 1, 2020, and forward will need to be sent to Prospect Medical Group. Claims and encounters can be submitted to Office Ally, payer ID PROSP and referrals should be submitted using our online provider portal, Aerial Care. The login information will be provided by our Prospect Medical Group Network Management team by July 31, 2020.
Claims & Encounter Submission.For Claims, use Payer ID: PPM01. For Encounters, use Payer ID: PPM02
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Our resources include: Referral Submission and Status Inquiry, Claims Status Inquiry, & Provider Dispute Resolutions Status Inquiry.
We have a web support team dedicated to you.
Direct Number: 951-280-7700
News About Cal Care IPA
Cal Care IPA serves Los Angeles County, which is home to approximately 2,500,000 Medicaid and approximately 1,030,000 Medicare beneficiaries. Cal Care IPA, along with Los Angeles Medical Center IPA, has contracted with 65 PCPs and have a network of 500 specialists, serving over 36,000 individuals, including approximately 36,000 Medi-Cal beneficiaries. Cal Care IPA is now contracted with Blue Cross, Care1st, Health Net, and Molina Healthcare!
Cal Care IPA has been dedicated to providing the highest level of commitment and support for its physicians since 1990. In addition, we are proud to be managed by Primary Provider Management Company Inc (PPMC).
Our goal is to provide the highest quality service and care to our members and providers.
Our New Provider Portal
A web-based HIPAA compliant application that enables secure data transactions to and from network providers. Features include: Referral Submission and Status Inquiry, Claims Status Inquiry, & Provider Dispute Resolutions Status Inquiry.
By developing user friendly products for our Customers, as well as building long lasting relationships with them, our goal is to be the highest volume processor of Healthcare Claims and the most affordable Clearinghouse in the Nation!
Cal Care IPA’s unique and powerful operating platform provides contracted physicians with the support to improve their clinical and operational efficiency. Providers benefit from the scale, market share and growth of Cal Care IPA which provide greater stability in patient volume. Additionally, physicians benefit from Cal Care IPA’s name recognition and sizeable patient base, which drives word of mouth patient referrals from friends and family. Importantly, Cal Care IPA’s capabilities have resonated well with PCPs and a majority of the Cal Care IPA’s providers have been with the Cal Care IPA for more than five years.
The role of the Utilization Management (UM) Department is to ensure consistent delivery of appropriate and quality health care services to our members. The UM functions include precertification, inpatient concurrent reviews, discharge planning, and retrospective reviews. The Utilization Management department makes decisions only on appropriateness of care and service, including existence of coverage. Cal Care IPA does not reward practitioners or other individuals for issuing denials of coverage or service care. There are no financial incentives that would encourage UM decision makers to make decisions that would result in under-utilization of services.