Claims

How to Submit Claims:  

Paper Claims (CMS 1500, UB04, PM160)

 Mail Claims to: EASY CARE MSO’s Clients (IPA and Hospital)

 ATTN: Claims Department

3900 Kilroy Airport Way, Suite 110 Long Beach , CA 90806

Electronic Claims : Office Ally

Payer ID Code: ECMSO

Direct EDI: Please call our IT Department at (562) 888-1415

Web Portal Submission: Please fill out our Web Portal Provider  Application to request access to our provider web portal. For any questions regarding the form, please contact Provider Contracting at

(562) 888-1415.

Time Frames for Submission: Filing deadlines

 Medi-Cal/Commercial Providers:

o Contracted Providers: 90 days (unless contract states otherwise)

o Non-Contracted Providers: 180 days Medicare Providers

o Contracted Providers: 90 days (unless contract states otherwise)

o Non-Contracted Providers: 365 days

PROVIDER DISPUTES:

Medi-Cal and Commercial  Providers:

Provider Disputes must be submitted within 365 days from the initial EOB/Correspondence in order for the claim to be reconsidered.

Please mail the provider dispute to: EASY CARE MSO, LLC

ATTN: Claims Dept. -Provider  Disputes 3900 Kilroy Airport Way, Suite 110 Long Beach , CA 90806

Medicare Providers (NonContracted): Provider Disputes must be submitted to the IPA/Medical Group, at the address listed below, within 120 calendar days after the notice of initial payment determination.

 Items that may be filed as Provider Disputes include:

Underpayment (payment less than the Medicare fee schedule); or Disagreement about our decision to make payment on submitted procedure code or down coding. You may submit your second level written request to the Health Plan if you disagree with our decision on your first level dispute by mail within 180 calendar days of written notice from us, or within 30 calendar days from the time we’ve received your request if you have not heard from us. Denials due to coverage determination and medical necessity determinations are not subject to provider dispute process . These items must be submitted as provider appeals.

 PROVIDER APPEALS:

 Medicare Non-Contracted  Provider Appeals:  Provider Appeals must be submitted  to the IPA/Medical Group within 60 calendar days after the receipt of notice of initial determination/decision. Providers who wish to submit provider appeals to the IPA/Medical Group must also submit a signed Waiver of Liability statement holding the member harmless regardless of the outcome of the appeal. Refer to Medicare Managed Care Manual,  Chapter  13, Section  60.l.l.

Level I: Provider Dispute/Provider Appeals Address:

EASY CARE MSO, LLC

ATTN : Provider Dispute/Provider Appeals 3900 Kilroy Airport Way, Suite 110 Long Beach CA 90806

Click Here for PDR Form: Easy Care MSO LLC Provider Dispute Resolution Request

2nd Level Provider Dispute/Provider  Appeals  Address:

Alignment Health Plan

Grievance & Appeals Dept.
1100 W. Town & Country Road #300 Orange, CA 92868
1(866)634-2247

 Blue Shield of California 

Appeals & Grievances Dept.
PO Box 927
Woodland Hills, CA 91365
1(800)963-8008

Brand New Day

Provider Appeals & Grievance Dept.
5455 Garden Grove Blvd, 5th Floor
Westminster CA 90755
1(866)255-4795

Care 1st Health Plan

Provider Dispute Dept.
PO Box 3829
Montebello CA 90640
1(323)889-5220

Central Health Plan

Appeals Dept.
1540 Bridgegate Dr.
Mail Stop 3000
Diamond Bar CA 91765
1(866)314-2427

Easy Choice Health Plan

Appeals & Grievances Dept.
10803 Hope Street, Suite B
Cypress, CA 90630
1(866)999-3945

 Humana Inc.

Appeals &Grievances Dept.
PO Box 14165
Lexington KY 40512
Non-contracted providers may fax the reconsideration to 1(800)949-2961

Molina Healthcare

Provider Dispute Resolution Unit
PO Box 22722
Long Beach CA 90801
1(800)869-7165