Participating Providers have the right to request a review of the information obtained from primary sources during the credentialing process (e.g. malpractice carriers, state licensing boards, National Practitioner Data Bank). If you suspect any erroneous information is contained in your credentialing file and you would like to request a review, please contact Credentialing Department, at 818 702-0100, extension 632 for details.

Freephone:+1 800-467-8484

As always, it is MedPOINT Management's standard to immediately inform participating providers should information received in the credentialing process vary substantially from the information supplied by the provider


Please inform us of your scheduled Facility Site Review with L.A. Care. As you know, one of the criteria for maintaining your status as a participating provider with contracted health plans is a satisfactory score in both medical records and facility operation. If you participate in the Medi-Cal Managed Care Program, this includes criteria considered Critical by LA Care Health Plan and its Plan Partners. Overall scores <80% or a Critical Criteria score <90% on a L.A. Care Health Plan Facility Site Review will effectively close your practice site to new enrollment until you have successfully completed the Corrective Action Plan as outlined by LA Care's description of deficiencies. Please contact the Quality Improvement Department when you receive notice of LA Care Facility Site Review. Should you need assistance in preparing prior to the LA Care visit or in the implementation of a Corrective Action Plan, we can schedule a time for a Quality Improvement Specialist to make a visit to your practice site. The Quality Improvement Department can be reached at 818 702-0100, extension 231 or 247.

Freephone:+1 800-467-8484


As you probably know by now, these is a state timeliness requirement for PM 160 INF forms. The PM 160 forms are due to the health plans by the 10th day of each month for the previous month's CHDP services.This means that MedPOINT must receive the completed forms by the 3rd of each month. Please note: Health Net has pre printed forms that can be submitted directly to them and they do not need to be routed to MedPOINT. Supplies of these forms will be sent to your office soon so the process can be expedited. There are a few quick tips to follow when filling out the forms:

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We Make Managed Care Manageable

MedPOINT Management provides the administrative services related to Utilization Review Services, Claims, Eligibility, Health Plan Benefits, Quality Management, Grievances and Provider Relations.

ELIGIBILITY:For eligibility verification,either swipe BIC card in the EDS (POS) device, call AEVS to verify or contact Health Plan. Have the member sign a waiver form making him/her financially responsible if he/she turns out to be ineligible.

UTILIZATION REVIEW: Requests to Global Care I.P.A. should be submitted through the MedPOINT PORTAL. To avoid delays in processing, it is necessary that all pertinent member information including eligibility, address, complete diagnosis, and ICD10 code, applicable procedure codes (CRVS, HCPIC) requested provider name, and medical criteria with supporting reports be legibly provided on each referral request.

DIRECT REFERRALS: Direct referrals are processed as soon as submitted.This is now the main way to refer a patient for the initial visit to a specialist but this must be made to a participating Global Care provider. All follow-up care must be prior authorized by the utilization review department. This protocol applies even when additional services are provided in conjunction with the initial consultation. Out of network referrals, as well as inpatient/outpatient services, require pre-certification. Specialty categories eligible for direct referrals are as follows: Cardiology, Dermatology, Endocrinology, Otolarygology, Ophthalmology, Immunology, Pulmonoloty, Podiatry, Ob-Gyn, Urology, Orthopedic, Plastic/Reconstructive surgery, Gastroenterology, Neurology, Surgery, Nephrology, Infectious diseases, Hematology/Oncology, and Rheumatology. The PCP should fax the completed direct referral authorization form to Global Care Medical Group on the same day the referral is generated. Please click for Download the DIRECT REFERRAL FORM

ROUTINE AUTHORIZATIONS: ROUTINE AUTHORIZATIONS take 5 Business days from the time received in MedPOINT's office. Letters are faxed or mailed to the PCP and the specialist. Determination letters are also mailed to the patient.

URGENT AUTHORIZATIONS: URGENT AUTHORIZATIONS are turned around within 72 business hours of your fax being received. We will call or Fax you as soon as determination has been made.

LAB: Quest Diagnostics (800) 339-4299 Lab work does not require prior authorization (except Chromosome Testing). All lab work must be referred to Quest Diagnostics.

X-RAYS: Basic X-rays must go to a Contracted Radiology Provider unless done in the Primary Care's office. Chest, Skull , Extremity and Mammography does not require prior authorization (direct referral). All other X-Rays: Ultrasound, CT's or MRI's require prior authorization.


Lab work does not require prior authorization (except chromosome testing). If you are not presently doing
business with Quest, contact them at the number above to obtain requisition forms, etc.
Quest is also contracted for BRCA Gene testing.
Lab costs for services associated with patient referrals to non‐contracted lab,…

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IPA financial responsibility varies by Health Plan. Authorization request may be redirected based on
contractual relationships when Health Plan or Hospital is financially responsible for DME.

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Outpatient Radiology is to be referred to RadNet free standing Radiology facilities. Do not refer to Hospital
Radiology Department for basic X‐Ray, Ultrasound, Mammogram, CT, MRI or Pet Scans. Please see the
website for locations, services and hours.

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DIRECT REFERRALS (X): Diagnostic X‐Ray, Fluoroscopy, Mammography & Ultrasound

  •  Diagnostic X‐ray, Fluoroscopy, Mammography & Ultrasound are considered to be a direct referral and do not require prior authorization. Providers will submit all direct referral requests through MedPOINT Management’s provider web portal.‐portal/
  •  X‐Rays: Exams do not require an appointment. Patients are seen on a walk‐in basis and will be taken…
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✅ RadNet will be providing Utilization Management services for your patients who need advanced imaging
studies. All non‐emergent requests for these services shall require authorization prior to scheduling. The
current authorization process will remain the same; providers will submit requests through MedPOINT
Management’s provider web portal.‐portal/

✅ If properly completed and legible, routine requests will be handled within 72 hours…

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FEE FOR SERVICE (FFS): All FFS requests go through Global Care Medical Group IPA

✅All non‐emergent requests for these services shall require authorization prior to scheduling. The
requesting physician shall submit these requests through Global Care Medical Group IPA via the provider portal.

✅Once authorization has been obtained, Global Care Medical Group IPA will send the authorization to
the indicated imaging center, which will then contact the patient for an appointment

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COPAY: Check membership card for copay. Collect copay at time of visit

BILLING: Encounter data must be submitted at least monthly on a Superbill or HFCA 1500 form for all Global patients. PM 160 forms are due at MedPOINT Management by the 3rd of each month for the previous month's CHDP services. PM 160 submission is required in addition to regular encounter claim.

Facility Site Review (FSR): All Health Plans will coordinate so that one FSR will apply to all Plans.