The new enrollments for the Affordable Care Act (ACA) are in full swing. L.A. Care has gained 9.5% of eligible L.A. County enrollment of Covered California members under L.A. Care Covered™ and a significant amount of new enrollments under Medi-Cal and other L.A. Care health plans. If you are an L.A. Care or L.A. Care Covered network provider, here are some tips on handling new member’s eligibility and claims.
Prior to service for all L.A. Care and L.A. Care Covered members, please be sure to check eligibility online or call us:
- If a member has received their ID card and eligibility has been confirmed: The member is officially effectuated, and you may charge the copay or coinsurance associated with the level of service provided based on the member’s plan or you may choose to wait and bill for that copay if you are so inclined, and wait until after the claim has processed. This will be a business decision you will make for your practice.
- If a member has not yet received an ID Card and eligibility is uncertain: you, the provider, should contact L.A. Care to verify if the member has been effectuated or if the member has a proposed effective date, and for instructions if the member’s eligibility is not confirmed. (If L.A. Care has confirmed eligibility as effectuated, see item 1 above.)
- For L.A. Care Covered members: Please call 1-855-270-2327 (L.A. Care Covered provider option: “2”)
- For all other L.A. Care members (Medi-Cal, Medicare Advantage HMO SNP, PASC-SEIU Plan, Healthy Kids): Please call L.A. Care Provider Services: 1-866-LA-CARE6 (1-866-522-2736)
We are here to assist you with any questions you may have.