FOR PROVIDERS
FOR PROVIDERS
Access claims submission, billing information, forms, and provider support resources.
Access clinical guidelines, medical necessity criteria, and patient care resources.
Compliance resources, required training, contact information, and policies for providers.
Contracted Health Plans Materials along with Training Guides and contact information for provider offices.
Access medical record requests, Risk Adjustment, HEDIS, and quality resources.
UM contact information, authorization status and resources for Choice Medical Group providers.
Access clinical guidelines, medical necessity criteria, and resources supporting quality patient care.
MCG Clinical Guidelines
Access medical necessity and clinical decision-support criteria used to support appropriate care decisions.
Timely Access to Care Standards
Access standards and appointment availability requirements for participating providers.
Preventive Health Guidelines
Preventive care guidelines and recommendations supporting quality patient care.
Patient Rights & Responsibilities
Information regarding patient rights and provider responsibilities.
Language Assistance Program (LAP)
Resources for providing language assistance and ensuring appropriate access to care.
Cultural Competency Resources
Training and resources to support culturally responsive and equitable patient care.
Advance Health Care Directive Resources
Resources to assist providers and patients with advance health care planning.
Immunization Guidelines & Schedules
Current immunization guidance and schedule resources for patient care.
Quality & Patient Experience Resources
Resources supporting quality initiatives, patient experience, CAHPS, HOS, and related programs.
Claim Status
Providers can check claim status through EZ-NET or by calling:
Main Line: 760-242-7777
Claims Submission
Claims may be submitted electronically through Office Ally or by mail.
Mailing Address:
Choice Medical Group / Choice Physicians Network
19111 Town Center Dr
Apple Valley, CA 92308
Office Ally Payer IDs
IPA Risk Claims: CMG01
CPN Risk Claims: CPN01
Appeals / PDRs
Appeals and PDRs must be submitted by mail.
Claims Department Management:
AVClaimsmanagement@choicemg.com
Access medical record request information, Risk Adjustment Coding, HEDIS, and Quality Improvement resources.
Medical Record Requests
Submit medical records for Risk Adjustment and HEDIS requests.
Email: MedicalRecords@choicemg.com
Fax: 760-513-9866
Phone: 760-242-7777, ext. 381
Required Information
Please include member information, date(s) of service or date range requested, rendering provider, and requested due date, if applicable.
Incomplete information may result in processing delays.
Risk Adjustment Coding & Quality Inquiries
For questions related to Risk Adjustment Coding or Quality Improvement:
Email: QualityCoding@Choicemg.com
A team representative will respond within 48 hours.
HEDIS & Quality Improvement Resources
Resources, tools, and information supporting HEDIS and Quality Improvement requirements.
Risk Adjustment Resources
Coding guidance, educational materials, and resources supporting accurate risk adjustment documentation.
Medical Record Documentation Resources
Guidance and reference materials supporting complete and accurate medical record documentation.
Aetna
Health plan training, compliance materials, and provider resources.
Alignment Health
Health plan training, compliance materials, and provider resources.
Anthem Blue Cross
Health plan training, compliance materials, and provider resources.
Blue Shield of California
Health plan training, compliance materials, and provider resources.
Health Net
Health plan training, compliance materials, and provider resources.
Humana
Health plan training, compliance materials, and provider resources.
SCAN Health Plan
Health plan training, compliance materials, and provider resources.
UnitedHealthcare
Health plan training, compliance materials, and provider resources.
Wellcare
Health plan training, compliance materials, and provider resources.
UM Phone: 760-242-7777
UM Fax: 760-242-1848
Authorization Status
Providers are encouraged to check authorization status through EZNET.
Appeals & Grievances
All appeals and grievances should be sent to:
appealsgrievances@choicemg.com
Affirmation Statement
Compliance affirmation and acknowledgement requirements.
PROVIDER SUPPORT
The Right Choice… to better your health.
Choice Medical Group provides coordinated healthcare throughout the High Desert by connecting patients with trusted primary care physicians, specialists, urgent care, wellness programs, and personalized support.
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