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Claims and Payment

All claims (including Retro Claims) must be mailed to:

Serra Community Medical Clinic

9375 San Fernando Rd.,

Sun Valley, CA 91352

To determine who is responsible for paying, please call Serra Medical Group or the Health Plan for explanation of benefits/eligibility.

Billing- All paper claims must be submitted on CMS 1500 form for professional services and UB-04 form for facility services.

Claims Adjudication- Each claim is subject to a comprehensive series of

quality checks called “edits” and “audits.” Quality checks verify and validate all claim information to determine if the claim should be paid, denied or

suspended for manual review. Edit and audit checks include verification of:

  • Data validity
  • Procedure and diagnosis compatibility
  • Provider eligibility on date of service
  • Recipient eligibility on date of service
  • Medicare or other insurance coverage
  • Claim duplication
  • Authorization requirements

Provider Disputes

When the claim is the responsibility of the Serra Medical Group, a provider dispute can be filed in writing to Serra Medical Group. Contact the Serra Medical Group for more information on how to file a claims dispute.

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