Total Care Under One Roof
   
 

Policies and Procedures
bullet Providers Disclosures
bullet Claim Filing
Time Frame
bullet Submission
of Claim
bullet Complete Claim
Definition
bullet Claims Submission
Information
bullet Acknowledgement
of Claims
bullet Denied or
Contested Claims
bullet Reimbursement
of Claims
bullet Interest on
Late Payment
bullet Overpayment
of Claims
bullet Dispute Resolution
Process
bullet

Fee Schedule

 

CONTRACTING PROVIDER DISCLOSURES

The following information is provided in accordance with 28 CCR 1300.71(o)(2), regarding disclosure of detailed payment policies and rules and nonstandard coding methodologies used to adjudicate claims. Serra Community Medical Clinic, Inc, in its sole discretion, employs the procedures set out in the following descriptions as part of its claims review, as indicated, of hospital and professional fee for service claims.

Providers may only look to Serra Community Medical Clinic, Inc, or if subcontracted to a Serra Community Medical Clinic, Inc capitated provider, to that provider, for payment and not to enrollees (except for required co-payments) or to any technical services vendor Serra Community Medical Clinic, Inc may use from time to time to assist in its review of claims