Phone Number (800) 877-2452 Fax (323)671-6050

Print

Eligibility Process

1. Clinics are placed in order form per package.
   • Each package requires a number eg. 1,2,3….
2. Clinics with CCS that do not require authorization
   • General Pediatrics (GPS)
   • Dermatology (DERM)
3. Clinics with CCS that require authorization for specific service.
   • Pulmonology (PULM)
   • Neonatology (NEO)

   Insurance That Require A written Form	Insurances that don’t require written form. These can be verified on the internet.
   Accordia National Aetna Cigna Kaiser United Healthcare ppo/commercial Others.	Blue Cross Medi-cal PPO, and HMO Health Net Pacificare and Universal Care

4. After writing out the forms for the insurances do the following:
   • Sort out insurance
   • Verify CCS first at all times
   • Verify Insurance that can be done via the internet
   • Verify commercial/others insurances.
5. HMO/Medi-cal Managed Care
   • Ask insurance Representative where to bill for professional fees
   • Ask for office co-pay
6. Insurance Eligibility
   • When verifying on the internet and no eligibility is found:
     • re-verify by phone
     • write out a form.
     • Don’t print out the cancelled form from internet.
7. Checking Eligibility:
   • When reading a POS
     • Health Net/ Molina
       • Call Health Net to verify eligibility
   • No Eligibility
     • Ask insurance representative for cancellation date
     • Self-Pay Pt
       • It is considered Financial counselor's responsibility to notify pt.
       • Leave paper work in the package