Medical group/IPA enrollment

Your choice of a PCP and medical group is important. Assess your family’s medical needs and define the type of physician you want. Our customer relations department can assist you with information about Providence Care Network’s primary care and specialty physicians. They can also provide you with the Provider ID numbers needed for your health plan enrollment forms. Once you have selected your PCP, you will need to inform your health plan of your decision. You can also check our physician directory to see a list of our physicians.

You will need to contact your health plan directly if you need to update your address or personal information.

Billing and claims

If you receive a bill and are unsure how to proceed, contact Providence Care Network’s customer relations department at 855-359-6323 and inform them of the type of bill you received. They will help determine if this was billed to you in error or if this amount is part of your co-insurance or co-payment benefit responsibility.

Accepted insurance

Managed care plans

• Aetna
• Anthem Blue Cross
• Blue Shield
• Cigna
• Health Net
• United Healthcare of California

Medicare Advantage plans

• Anthem Blue Cross Senior
• Blue Shield 65 Plus
• Health Net Senior
• MD Care
• Secure Horizons

Utlilization management policy

Procedures and criteria are disseminated to members upon request.

Disclosure notice:

The materials provided to you are guidelines used by the medical group to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and benefits covered under your contract. Those are guidelines and do not constitute the standard of care.

• Providence Care Network will disclose a list of network providers to members, upon request.
• Utilization Management medical clinical guidelines will be disclosed to members and practitioners, upon request.
• All Utilization Management decisions are based on appropriateness of care and service.
• Providence Care Network/Foundation does not compensate practitioners for individual denials.
• Providence Care Network/Foundation does not offer incentives to encourage denials.
• Providence Care Network/Foundation does not have the financial incentives that would encourage decisions that would impact under/over-utilization of care, service or available member benefits.

For questions or concerns that are related to a referral that your provider has submitted,  call 855-359-6323. Hearing or speech-impaired members (TTY users) can call 711 relay services. Collect calls are accepted for patient referral matters, and Spanish speaking staff members are available.

Download the provider directory

Provider forms and information

Following is some information regarding claims processing and payment. For your convenience, attached are the required forms on the provider dispute resolution process.

• Provider dispute resolution request form
• Provider dispute resolution turnaround time guidelines
• Complete claims processing guidelines
• AB1455 claims definitions
• AB1455 claims time limits 

You may complete and fax back the provider dispute resolution request form to the Providence Care Network Provider Services team at 213-351-4398.

For more information you may also visit the Industry Collaboration Effort website.