Administrative Services

MedPOINT Management provides the administrative services related to Utilization Review Services, Claims, Eligibility, Health Plan Benefits, Quality Management, Grievances and Provider Relations.
Global Care Medical Group IPA Managed by MedPOINT Management. We Make Managed Care Manageable

PROVIDERS HAVE RIGHTS!!

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 Ann McMunn, Credentialing Supervisor, at 818 702-0100, extension 247 for details.
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

MedPOINT MANAGEMENT IS HERE TO HELP!

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.

PM 160 INF QUICK TIPS

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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PRIOR AUTHORIZATIONS (A): MRI, MRA, CT, DEXA, SPECIALS, NUCLEAR MEDICINE & PET/CT

✅ 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. http://www.medpointmanagement.com/provider‐portal/

✅ If properly completed and legible, routine requests will be handled within 72 hours of receipt. More
urgent request should be designated as “URGENT” and will be handled within 24 hours.

✅ Requests may be pended for additional information and will be held no longer than 2 business days
before returned to the ordering physician.

✅ Requesting physicians will be notified of cases that are not recommended as requested. Appeals should
be directed to the RadNet medical staff. Should there be a disagreement as to the disposition of the
request, the Global Care Medical Group IPA medical director will serve as the final authority to approve
or deny the service.

✅ MRI, MRA, CT, DEXA, SPECIALS, NUCLEAR MEDICINE & PET/CT: Once authorization has been
obtained a RadNet scheduler shall contact the patient for an appointment.

✅ In case of an emergency/STAT, requesting provider should call the imaging facility directly to
schedule the appointment. The request will be scheduled without prior authorization but should be
entered into the MedpointManagement.com portal and noted as “scheduled direct with imaging
facility as a stat”

AFFILIATED HOSPITALS
AFFLIATED HOSPITALS PLANS
Beverly Hospital--Montebello
California Hospital Medical Center*
Centinela Hospital Medical Center
Children’s Hospital of Los Angeles (Tertiary)
East LA Doctor’s Hospital
Glendale Adventist Medical Center
Hollywood Presbyterian Medical Center*
Huntington Memorial Hospital (Tertiary)
L.A. Community Hospital – Los Angeles & Norwalk
Long Beach Memorial Medical Center
Martin Luther King Jr. Community Hospital
Memorial Hospital of Gardena
Miller Children’s Hospital (Tertiary)
Providence Little Company of Mary – San Pedro & Torrance
San Gabriel Valley Medical Center
Southern CA Hospital—Culver City & Hollywood
St. Francis Medical Center
St. Mary Medical Center
White Memorial Medical Group
Legend: * Full Risk Partners for Medi-Cal Enrollees

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