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19-936 Submit Additional Claims Info to MedPOINT Management When CCIPA Is Financially Responsible
Date: 12/04/19
Submit Additional Claims Info to MedPOINT Management When CCIPA Is Financially Responsible
Avoid delays by correctly routing requested info
As a reminder, if a member is associated with Community Care IPA (CCIPA) and CCIPA is responsible for claims payment, submit additional documentation (such as medical records) to MedPOINT Management, not to California Health & Wellness Plan (CHWP), when such information is requested by CCIPA for their delegated claims processing.
For dates of service on or after May 1, 2019, CCIPA is delegated for claims payment of:
· Professional services.
· The professional and technical component of outpatient diagnostic testing (lab, radiology, biopsies [procedures performed to diagnose a condition, illness or injury]).
· Outpatient rehabilitation (physical therapy, occupational therapy, speech therapy, respiratory therapy, and pulmonary therapy).
· Outpatient dialysis.
· Urgent care.
· Other miscellaneous services.
CHWP is responsible for facility services (hospital, emergency department, ambulatory surgical center, and skilled nursing facility), home health, durable medical equipment (DME), and other miscellaneous services.
How to submit claims, provider disputes and documentation
Providers are strongly encouraged to submit new claims electronically. If you are interested in setting up electronic submission with CHWP or CCIPA, please contact CHWP Provider Services at 1-877-658-0305 or CCIPA at 1-866-423-0060.
If submitting new claims or forms electronically is not possible, mail paper claims or forms to the appropriate address listed in the table on page 2.
Provider dispute forms and requests for additional documentation to review a provider appeal should also be mailed to the appropriate address listed in the table.
Additional information
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.
To contact CCIPA, call 1-866-423-0060.
Claims, provider disputes and documentation submissions
Responsible party |
Type of material |
Mailing address |
Submit provider disputes and documentation requests to: |
CHWP |
Claims |
California Health & Wellness Attn: Claims PO Box 4080 Farmington, MO 63640-3835 |
California Health & Wellness Attn: Claims PO Box 4080 Farmington, MO 63640-3835 |
CHWP |
Plan appeals and second- level IPA appeals |
California Health & Wellness Attn: Claim Disputes PO Box 4080 Farmington, MO 63640-3835 |
California Health & Wellness Attn: Claim Disputes PO Box 4080 Farmington, MO 63640-3835 |
CCIPA |
Claims |
Preferred (electronic submission): Office Ally Payer ID: MPM 48
Other (mail-in, if electronic option is not available): MedPOINT Management PO Box 7020-04 |
MedPOINT Management PO Box 7020-04 Telephone: 1-866-423-0060 Fax: 1-888-556-2291 |
CCIPA |
IPA appeals |
MedPOINT Management PO Box 7020-04 Telephone: 1-866-423-0060 Fax: 1-888-556-2291 |
MedPOINT Management PO Box 7020-04 Telephone: 1-866-423-0060 Fax: 1-888-556-2291 |