Where To Submit

Claims Submit claims for review to:

Future Care IPA
5000 Airport Plaza Drive, Suite 150
Long Beach, CA, 90815-1260

Internet

https://WWW.AMM.CC
(Click to select IPA Website)

Fax

(562) 766-2007

Clearinghouse
Office Ally – Payer ID # AMM04
Capario – Payer ID # FCI01

 

Claim Document Completion and Submission


To expedite processing, all claims submitted must be complete according to Federal and State of California guidelines.

Title 28 California Code of Regulations (CCR)

Section 1300.71 (a)(2)(B)(i)(ii)
AB1455 Page 2 Lines 12-18

For institutional providers:

the completed UB92 data set or its successor format adopted by the National Uniform Billing Committee (NUBC), submitted on the designated paper or electronic format as adopted by the NUBC;
entries stated as mandatory by NUBC and required by federal statute and regulations; and any state-designated data requirements included in statutes or regulations.

Section 1300.71 (a)(2)(D)(i)
AB1455 Page 2 Line 23; Page 3 Lines 1-3

For physicians and other professional providers:

the Centers for Medicare and Medicaid Services (CMS) Form 1500 or its successor adopted by the National Uniform Claim Committee (NUCC) submitted on the designated paper or electronic format.

Federal Code of Regulations – Title 42

Part 424 Subpart C Section 424.30 through 424.40

Institutional Providers
  • Must be on UB92 claim form.

Professional Providers
  • Must be on CMS 1500 claim form

  • Can’t submit more than six lines of service on one claim

  • For referred and/or ordered Services the name of the referring or ordering physician and the NPI or UPIN numbers must be present in box 17 and 17A

Coding Requirements

Title 28 California Code of Regulations (CCR)

Section 1300.71 (a)(2)(D)(ii)
AB 1455 Page 3 Lines 4-5

Current Procedural Terminology (CPT) codes and modifiers and International Classification of Diseases (ICD-9CM) codes;
Section 1300.71(a)(2)(D)(iii)
AB 1455 Page 3 Lines 6-8
Entries stated as mandatory by NUCC and required by federal statute and regulations; and any statedesignated data requirements included in statutes or regulations

Federal Code of Regulations – Title 42

Part 424 Subpart C Section 424.32 (1), Section 424.32 (2), and Section 424.34 (4)
Must have appropriate coding

  • CPT Level I codes

  • Appropriate CPT and/or HCPCS modifiers

  • HCPCS National Level II Codes

  • HCPCS Local Level III Codes

  • ICD-9-CM

Medicare requires that all claims contain codes for patient diagnoses and for procedures provided.