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KEY:MCLA:Medi-CalPS:PASC-SEIU (Formerly IHSS)LAC:L.A. Care Covered (Covered CA ExchangeProduct)LACCD: L.A. Care Covered DirectCMC:Cal MediConnectSR: Shared Risk ContractFR: Full Risk ContractDR: Dual Risk ContractFFS: Fee for ServiceAuthorizations: Standard County responsible for DHSin network onlyGeneral Overview; For specific questionsregarding contracted sevices,authorizations,or DOFR's, please reach out to thePPG/MSO at phone number provided.RegionCodesParticipating Provider GroupManagement Company(MSO)PhonePlease note for Sub Acute and Skilled Nursing Facilities, please refer to the SNF Auth/Billing Reference Guide.For All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidPSLAC &LACCDCMC NonInstitutional AidAUTHORIZATIONSAUTHORIZATION FAX #Member's Capitated Hospital:White Memorial Medical CenterDRAHPNAdventist Health Physician NetworkMedPOINT ManagementNew MSO Effective 2/1/2021818-702-0100PPGExtended747-287-0119L.A. CARESRL.A. CARESRAHFAIDS HealthCare Foundation888-238-7463N/AL.A. CAREFFSPAYORFFSFFSFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066L.A. CAREMember's Capitated Hospital:Alhambra Hospital Medical CenterDRAPIAAllied Physicicians dba Allied Pacific IPANetwork Medical Management626-282-0288SRExtendedL.A. CAREPPGMember's Capitated Hospital:Alhambra Hospital Medical CenterDRDRTermed1/31/2021APWM626-943-6382Member's Capitated Hospital:White Memorial Medical CenterMember's Capitated Hospital:Citrus Valley Medical CenterDRAPCVCitrus Valley Independent Physicians(subsidiary of Allied)Network Medical Management626-282-0288ExtendedPPGL.A. CARESRMember's Capitated Hospital:Citrus Valley Medical CenterDRL.A. CAREAMHSAltaMed Health Services Corporation866-880-7805ExtendedPPGL.A. CARESRAltura Management ServicesL.A. CARESRAMHNAltaMed Health Network, ed 6.2.2021)PAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSAdventist Health Managed Care ClaimPO Box 16237Portland, OR 97292Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081HealthSource MSO100 N. Stoneman Avenue #202Alhambra, CA 91801Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081HealthSource MSO100 N. Stoneman Avenue #202Alhambra, CA 91801Adventist Health Managed Care ClaimPO Box 16237Portland, OR 97292PO Box 840147Los Angeles, CA 90084-0147Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PO Box 840147Los Angeles, CA 90084-0147Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code ALTMA orP.O. Box 7280Los Angeles, CA 90022-7280PAYOR CLAIMS PHONE #(503) 261-6032(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(626) 570-1606(888) 4LA-Care (452-2273)(626) 570-1606(503) 261-6032(626) 814-2504(888) 4LA-Care (452-2273)(626) 814-2504(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(855) 848-5252Page 1
RegionCodesParticipating Provider GroupManagement Company(MSO)PhoneFor All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidOMGAOmnicare Medical Group - AMHN866-880-7805PSLAC &LACCDCMC NonInstitutional AidExtendedAUTHORIZATIONS323-720-5602AUTHORIZATION FAX #PPGPPGFRAltura Management ServicesNew MSO Effective 2/1/2021OMNIOmnicare Medical Group866-880-7805SRExtendedL.A. CAREPPGL.A. CARESRL.A. CARESRAIPAAngeles IPAHealthSmart ManagementServices Organization, Inc.714-947-8600PPGExtended714-947-8782L.A. CARESRL.A. CARESRAMGSOptum Care Network - LA Family Community(fka Apple Care Medical Group, St. Francis, Inc)AppleCare Medical Management800-460-5051ExtendedPPGL.A. CARESRSRAPPLOptum Care Network - Apple Care Select(fka Apple Care Medical Group, Inc.)AppleCare Medical -676-0786714-676-0787714-676-0789DRAMGWApple Care Medical Group, Inc Whittier RegionAppleCare Medical Management800-460-5051ExtendedBVMGAxminster Medical GroupBella Vista IPA310-675-5370MedPOINT . CARESRL.A. CAREExtendedPPG818-444-1209L.A. CAREL.A. CARESRL.A. CARESRCitrus Valley Physician GroupPhysicians Data Trust, Inc562-860-8771SRExtendedPPG760-477-2951DRL.A. CARESRCommunity Family CareNetwork Medical Management818-396-1232855-888-4232ExtendedPPGL.A. CARESRL.A. CARESRL.A. CARESRCFCACommunity Family Care - Antelope ValleyNetwork Medical FCMCFCVNetwork Medical y Family Care - Memorial Hospital of GardenaNetwork Medical y Family Care - Valley Presbyterian HospitalNetwork Medical 26-521-6144L.A. CARESRSRCommunity Family Care - East Los Angles DoctorsHospitalL.A. CAREL.A. CAREMember's Capitated Hospital:Citrus Valley Medical CenterSRCFCL.A. CAREMember's Capitated Hospital:St. Francis Medical CenterL.A. CARESRCVPGL.A. CAREPPGSRAXMGPAYORPPGPPGPPG(Updated 6.2.2021)L.A. CAREMember's Capitated Hospital:East Los Angeles Doctor's HospitalEffective 1/1/2021Member's Capitated Hospital:Memorial Hospital of GardenaEffective 1/1/2021Member's Capitated Hospital:Valley Presbyterian HosptialEffective 1/1/2021PAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code ALTMA orP.O. Box 7280Los Angeles, CA 90022-7280Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081P.O. Box 6028Artesia CA 90702Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PO Box 840147Los Angeles, CA 90084-0147Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081ConiferP.O Box 260890Encino, CA 91436ConiferP.O Box 260890Encino, CA 91436ConiferP.O Box 260890Encino, CA 91436PAYOR CLAIMS PHONE #(855) 848-5253(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(714) 443-4500(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(626) 814-2504(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(818) 461-5000(818) 461-5000(818) 461-5000Page 2
RegionCodesParticipating Provider GroupManagement Company(MSO)PhoneFor All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidPSLAC &LACCDCMC NonInstitutional AidAUTHORIZATIONSAUTHORIZATION FAX #L.A. CARESRCRCMCrown City Medical GroupMedPOINT Management818-702-0100PPGExtended818-960-0613L.A. CARESRL.A. CARESRAVHCDHS-Antelope Valley Health CenterDHS- Managed Care Services800-832-6334, option 1StandardSRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Bellflower Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066CTHCDHS-CURTIS TUCKER HEALTH CENTERDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Dollarhide Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-East Los Angeles Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066EMCHDHS-El Monte Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066ERCHDHS-Edward R Roybal Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Glendale Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066HCHCDHS-H Claude Hudson Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066HDHSDHS-High Desert Multi-Service Ambulatory Care CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Hubert H Humphrey Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Harbor/UCLA Medical Center (hospital-basedclinic)DHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREL.A. CAREDRHUMCL.A. CAREL.A. CAREDRHHHCL.A. CAREL.A. CAREDRSRL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRGPHCL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRELHCL.A. CAREL.A. CAREDRDHHCL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRBHCPAYORL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066L.A. CAREL.A. CAREDR(Updated 6.2.2021)PAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PAYOR CLAIMS PHONE #(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)Page 3
RegionCodesParticipating Provider GroupManagement Company(MSO)PhoneFor All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidHUMFDHS-Harbor/UCLA Family Health CenterDHS- Managed Care Services800-832-6334, option 1StandardPSDRLAC &LACCDCMC NonInstitutional AidAUTHORIZATIONSAUTHORIZATION FAX #L.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066LACUDHS-LAC USC Medical Center (hospital-based clinic)DHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066LBCHDHS-Long Beach Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Little Rock Community ClinicDHS- Managed Care Services800-832-6334, option 1StandardSRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Lake Los Angeles Community ClinicDHS- Managed Care Services800-832-6334, option 1StandardSRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066LPHCDHS-La Puente Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Martin Luther King Jr. Multi-Service AmbulatoryCare CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Mid-Valley Comprehensive Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066NHCDHS - Northeast Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066OVMCDHS-Olive View/UCLA Medical Center (hospital-basedclinic)DHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Rancho Los Amigos National RehabilitationCenter (hospital-based clinic)DHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-San Fernando Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066SGHCDHS-East San Gabriel Valley Health CenterDHS- Managed Care Services800-832-6334, option 1StandardL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-South Valley Health CenterDHS- Managed Care Services800-832-6334, option 1StandardSRL.A. CAREDRL.A. CAREL.A. CAREDRSPHCL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRSFHCL.A. CAREL.A. CAREDRRLACL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDROVMVL.A. CAREL.A. CAREDRMLKHL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRLLACL.A. CAREL.A. CAREDRLCCL.A. CAREL.A. CAREDRDRL.A. CAREL.A. CAREDRDRPAYOR(Updated 6.2.2021)FACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066L.A. CAREL.A. CAREPAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PAYOR CLAIMS PHONE #(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)Page 4
RegionCodesParticipating Provider GroupManagement Company(MSO)PhoneFor All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidSTRDHS-Star ClinicDHS- Managed Care Services800-832-6334, option 1StandardPSLAC &LACCDCMC NonInstitutional AidDRAUTHORIZATIONSAUTHORIZATION FAX #L.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Torrance Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-Wilmington Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066DHS-West Valley Health CenterDHS- Managed Care Services800-832-6334, option 1StandardDRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066El Proyecto Del Barrio, Inc.MedPOINT eptional Care Medical GroupConifer Health Solutions818-461-5000StandardL.A. CARESRFCSFamily Care Specialists IPA, A Medical Group Inc.MedPOINT Management818-702-0100StandardSRL.A. CAREFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066FACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066MedPOINT Management818-702-0100ExtendedPPG818-702-1730L.A. CARESRL.A. CARESRL.A. CARESRHCLAHealth Care LA, IPAMedPOINT lth Care LA, IPA - Valley PresbyterianMedPOINT PG818-702-1722PPGREGION 1: 626-254-8215REGION 2: 213-861-5856REGION 3: 310-244-6964REGION 4: 310-224-6962REGION 5: 818-827-9811REGION 6: 714-436-4801SRHCPMOptum Health Plan of California(fka HealthCare Partners Medical Group)310-793-5412ExtendedL.A. CAREL.A. CARESRHCLVL.A. CAREL.A. CARESRGlobal Care IPAL.A. CAREL.A. CARESRGCMGL.A. CAREL.A. CARESRECMGL.A. CAREL.A. CAREDREPDBL.A. CAREL.A. CAREDRWVCHL.A. CAREL.A. CAREDRWIHCL.A. CAREL.A. CAREDRTHCPAYORSRMember's Capitated Hospital:Valley Presbyterian HosptialEffective 4/1/2021L.A. CAREL.A. CAREL.A. CARESRPAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580LosCA 90081Office Ally Angeles,Payor CodeLACAR orP.O. Box 811580CA 90081Office LosAlly Angeles,Payor CodeLACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Valley Presbyterian Hospital HCLAP.O Box 7020-09Tarzana, CA 91357Office Ally Payor Code MPM53Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PAYOR CLAIMS PHONE #(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(818) 702-0100(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)(888) 4LA-Care (452-2273)FRHDHigh Desert Medical GroupHeritage Provider Network661-945-5984ExtendedPPG661-952-3690PPG43839 N 15th Street WestLancaster, CA 93534(661 )945-5984PPGBURBANK/LA: 818-933-0510SAN FERNANDO VALLEY: 818-933-0538GLENDALE: 818-396-3479SAN GABRIEL VALLEY: 626-774-2299PPGP.O.Box 371390Reseda, CA 91337(213) 355-8988Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081(888) 4LA-Care (452-2273)FRFRFRLAKELakeside Medical GroupHeritage Provider Network213-355-8988ExtendedFRFRPPNPIH Health Physicians(fka Pioneer Provider Network)HealthMed Servies, Inc.562-789-5401ExtendedSRPPG(Updated 6.2.2021)FACE SHEET: 562-967-2969ALL OTHERS: 562-967-2947L.A. CAREPage 5
RegionCodesParticipating Provider GroupPPNPIH Health Physicians(fka Pioneer Provider Network)Management Company(MSO)HealthMed Servies, Inc.Phone562-789-5401For All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusExtendedMCLA NonInstitutional AidPSLAC &LACCDCMC NonInstitutional AidAUTHORIZATIONSPPGAUTHORIZATION FAX #FACE SHEET: 562-967-2969ALL OTHERS: 562-967-2947PAYORL.A. CARESR(Updated 6.2.2021)PAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081PAYOR CLAIMS PHONE #(888) 4LA-Care (452-2273)Page 6
RegionCodesParticipating Provider GroupManagement Company(MSO)PhoneFor All Lines of Business: Professional Authorizations and Payments are responsibility of PPGSee chart below for Facility & Lower Level of Care such as DME and Home Health responsibility based on line of businessDelegation StatusMCLA NonInstitutional AidPSLAC &LACCDCMC NonInstitutional AidAUTHORIZATIONSAUTHORIZATION FAX #L.A. CARESRPVMGPomona Valley Medical GroupProspect Medical Systems/ProMed Health Network909-932-1045ExtendedPPGSRPVHMC: 714-941-5210ALL OTHER FACILITIES: 714-561-7609DISCHARGE ORDERS: 909-936-3608L.A. CARESRPreferred IPA of CaliforniaThrifty Management VPreferred IPA - Valley PresbyterianThrifty Management Services800-874-2091Medpoint PG800-874-2093PPGMCLA: 818-444-1209ALTA: 714-560-7379DIGNITY: 714-560-7356OTHERS: 714-560-7621OUT OF AREA: 714-560-7622SRPROHExtendedProspect Healthsource Medical Group, Inc.Prospect Medical Systems/ProMed Health NetworkSR714-796-5719DRMedpoint ManagementProspect Medical Group Los Angeles, Inc.714-796-5719818-702-0100L.A. CAREExtendedProspect Medical Group, Inc.Prospect Medical Systems/ProMed Health NetworkPPGSR714-796-5719MCLA: 818-444-1209ALTA: 714-560-7379DIGNITY: 714-560-7356OTHERS: 714-560-7621OUT OF AREA: 714-560-7622DRMedpoint 00L.A. CARESRPROFExtendedProspect Professional Care Medical Group, Inc.Prospect Medical Systems/ProMed Health NetworkPPGL.A. CAREMember's Capitated Hospitals:ALTA Los Angeles Community HospitalSR714-796-5719DRFRREMGRegal Medical GroupHeritage Provider Network213-355-8988ExtendedPPGFRFRSEAMemorialCare Select Health Plan(fka Seaside Health Plan)855-367-7747StandardSRL.A. CAREBURBANK/LA: 818-933-0510SAN FERNANDO VALLEY: 818-933-0538GLENDALE: 818-396-3479SAN GABRIEL VALLEY: 626-774-2299FACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066SRSHISerendib Healthways, Inc.Conifer Health SolutionsL.A. CAREL.A. CAREMember's Capitated Hospitals:ALTA Los Angeles Community HospitalSRDRMedpoint ManagementL.A. CAREMember's Capitated Hospitals:ALTA Los Angeles Community HospitalPPGExtendedProspect Nuestra FamiliaProspect Medical Systems/ProMed Health NetworkL.A. CAREMember's Capitated Hospitals:ALTA Los Angeles Community HospitalL.A. CAREMember's Capitated Hospitals:ALTA Los Angeles Community HospitalSRSRPROVL.A. CAREPPGDRMedpoint ManagementL.A. CAREMember's Capitated Hospital:Valley Presbyterian HosptialEffective 3/1/2021L.A. CAREExtendedProspect Medical Systems/ProMed Health NetworkL.A. CARE818-702-0100SRPROSL.A. CAREL.A. CARESRPIPAPAYOR818-461-5000StandardL.A. CARESRSRFACE SHEET: 877-314-4957CLINICAL REVIEW: 213-438-5063DISCHARGE ORDER: 213-438-5066PPGPAYOR ELECTRONIC CLAIM INFO/ CLAIMSADDRESSOffice Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580CA 90081Office LosAlly Angeles,Payor CodeLACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081ConiferP.O Box 260890Encino, CA 91436Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081P.O. Box 11466Santa Ana, CA 92711-1466Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081P.O. Box 11466Santa Ana, CA 92711-1466Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081Office Ally Payor Code LACAR orP.O. Box 811580Los Angeles, CA 90081P.O
HealthSmart Management Services Organization, Inc. 866-880-7805 Extended. BVMG. MedPOINT Management 818-702-0100 Extended. Extended . Altura Management Services. New MSO Effective 2/1/2021 APPL. PPG PPG. Extended 323-720-5602. Extended. PPG. Extended. AIPA. 714-947-8600. Community Family Care - Antelope Valley. Citrus Valley Physician Group .
