NEW Effective January 1, 2004, contracted providers and their claims processing organizations are required to be in full compliance with California regulations promulgated under AB 1455/SB 1177…2000). These regulations set standards for claims processing and dispute resolution mechanisms to facilitate the prompt and efficient submission, processing and payment of claims and fast, fair and cost-effective dispute resolution.
Serra medical Group, Inc work teams began preparing to meet these new standards months in advance. Our claims, provider network and contracts, reporting, and provider appeals functions have been intensely scrutinized and where necessary, modified and enhanced to meet the new regulatory standards. Using this website as a critical mechanism for communicating with providers, Serra medical Group, Inc will keep providers who serve our patients more fully informed of the group’s claims settlement practices and policies.
POLICIES AND PROCEDURES
- Member Rights
- Clinical Practice Guidelines
- Access to Care
- Advanced Directives
- Affirmative Statement
- California Children’s Services (CCS)
- Minor Consent and Rights of Claims
- UM Decision Making
- Denials
- Women’s Health Services
- Customer Service and Cultural & Linguistics
- After Hours and Urgent Care
- Authorizations and Referrals
- Behavioral Health
- Claims and Payment
- Child Health and Disability Prevention (CHDP)
- Marketing Guidelines
- SMG Referral Request Form
- Cultural Awareness Training
- Fraud, Waste and Abuse/Compliance Training
- Providers Disclosures
- Claim Filing Time Frame
- Complete Claim Definition
- Claims Submission Information
- Acknowledgement of Claims
- Denied or Contested Claims
- Reimbursement of Claims
- Overpayment of Claims
- Dispute Resolution Process
- Fee Schedule
- Policies
