We Make Managed Care Manageable

Global Care Medical Group IPA
Managed by MedPOINT Management

 


MedPOINT Management provides the administrative services related to Utilization Review Services, Claims, Eligibility, Health Plan Benefits, Quality Management, Grievances and Provider Relations.

ELIGIBILITY: For eligibility verification,either swipe BIC card in the EDS (POS) device, call AEVS to verify or contact Health Plan. Have the member sign a waiver form making him/her financially responsible if he/she turns out to be ineligible.

UTILIZATION REVIEW: Fax referral worksheet requests to Global Care I.P.A.™ at (818) 702-9695 or mail to P.O. Box 571420, Tarzana CA 91357. To avoid delays in processing, it is necessary that all pertinent member information including eligibility, address, complete diagnosis, and ICD9 code, applicable procedure codes (CRVS, HCPIC) requested provider name, and medical criteria with supporting reports be legibly provided on each referral request.

DIRECT REFERRALS: This is now the main way to refer a patient for the initial visit to a specialist but this must be made to a participating Global Care™ provider. All follow-up care must be prior authorized by the utilization review department. This protocol applies even when additional services are provided in conjunction with the initial consultation. Out of network referrals, as well as inpatient/outpatient services, require pre-certification. Specialty categories eligible for direct referrals are as follows: Cardiology, Dermatology, Endocrinology, Otolarygology, Ophthalmology, Immunology, Pulmonoloty, Podiatry, Ob-Gyn, Urology, Orthopedic, Plastic/Reconstructive surgery, Gastroenterology, Neurology, Surgery, Nephrology, Infectious diseases, Hematology/Oncology, and Rheumatology. The PCP should fax the completed direct referral authorization form to Global Care Medical Group on the same day the referral is generated.

ROUTINE AUTHORIZATIONS take 48 hours from the time received in MedPOINT's office. Letters are faxed or mailed to the PCP and the specialist. Determination letters are also mailed to the patient.

URGENT AUTHORIZATIONS are turned around within 6-8 business hours of your fax being received. We will call or Fax you as soon as determination has been made.

LAB: UNILAB (800) 339-4299 Lab work does not require prior authorization (except Chromosome Testing). All lab work must be referred to UNILAB.

X-RAYS: Basic X-rays must go to a Contracted Radiology Provider unless done in the Primary Care's office. Chest, Skull , Extremity and Mammography does not require prior authorization (direct referral). All other X-Rays: Ultrasound, CT's or MRI's require prior authorization.


CONTRACTED RADIOLOGY PROVIDERS

  • Arcadia Radiology (San Gabriel Valley Medical Center).

  • Brotman Medical Center Radiology.

  • California Hospital Medical Center Radiology.

  • Cedars-Sinai Medical Center Imaging Center.

  • Centinela Hospital Medical Center Radiology.

  • Coast Radiology and Medical Imaging (St. Mary and Suburban Medical Center).

  • Community Radiology (Long Beach Community Hospital).

  • Daniel Freeman Hospital Inglewood and Marina.

  • Hawthorne Radiological Associates.

  • Good Samaritan Hospital.

  • Inglewood-Marina Radiology.

  • Long Beach Medical Imaging Clinic (freestanding).

  • Long Beach Community Radiology.

  • Memorial Hospital of Gardena Radiology.

  • Midway Hospital Radiology.

  • Robert F. Kennedy Medical Center Radiology.

  • Radiographica Medica (free standing).

  • Redondo Imaging Center (free standing).

  • St. Francis Medical Center Radiology.

  • St. Mary Medical Center Imaging Center.

  • Suburban Medical Center Radiology.

  • Tower Imaging & Rad-Net.

  • Turner Diagnostic Imaging (free standing).

  • Westchester Imaging Center (free standing).

  • Western Imaging Center (free standing).



COPAY: Check membership card for copay. Collect copay at time of visit.

BILLING: Encounter data must be submitted at least monthly on a Superbill or HFCA 1500 form for all Global patients. PM 160 forms are due at MedPOINT Management by the 3rd of each month for the previous month's CHDP services. PM 160 submission is required in addition to regular encounter claim.



Administrative
Services