Question 1

What is an IPA?

Accepted Answer

An IPA or an Independent Physicians Association consists of a panel of physicians who contract with health plans and hospitals to provide complete care to members of Health Maintenance Organizations (HMO). All HMO members must first select a Primary Care Physician (PCP), who belongs to an IPA or medical group. IPA doctors and their staff then coordinate a comprehensive health care delivery system among the medical providers within the network.

Question 2

Who can join an IPA?

Accepted Answer

Anyone with HMO insurance can and needs to join an IPA.

Question 3

How do I become a Pacific Associates member?

Accepted Answer

To join Pacific Associates IPA, Please refer to How to join Pacific Associates IPA) page. For more inquiries, please call (562) 387-0403 and speak with one of our customer service representatives.

Question 4

Where is the Pacific Associates service center located ?

Accepted Answer

The Pacific Associates member service center is located at 9900 Lakewood Blvd., Suite 103,  Downey, CA 90240. We welcome walk-in members Monday to Friday 8am-5pm. For more inquiries, please call (562) 387-0403.

Question 5

What are the hours of operation for Pacific Associates IPA?

Accepted Answer

Member service center: Monday to Friday from 8AM to 5PM.

Question 6

What do I do in case of a medical emergency?

Accepted Answer

In case of a life threatening emergency, please dial 911. For non-life-threatening emergencies, please call one of our contracted After Hours Urgent Care Centers.

Question 7

What do I do if I would like to see a physician at after work but my family doctor’s office is already closed?

Accepted Answer

Pacific Associates offers several After Hours Care Centers throughout Southern California to service our members in medical needs.

Question 8

How do I choose or change my family doctor?

Accepted Answer

Family doctor is commonly referred to as PCP (Primary Care Physicians). When you enroll into a HMO plan, you need to choose a designated PCP within the IPA network. For our network of contracted PCPs, please click here. If you would like to change your PCP, please contact your Health Plans for details.

Question 9

What is my co-pay?

Accepted Answer

Co-pay or co-payment is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. A member’s co-payment varies depending on the type of insurance they have. Please contact your Insurance carrier for co-payment information.

Question 10

What is an authorization?

Accepted Answer

An authorization is an approval to go see a specialist that is usually requested through your primary care physician.

Question 11

What happens when my authorization gets denied?

Accepted Answer

An authorization may be denied for many reasons. Please contact our customer service at (562) 387-0403 for complete details.

Question 12

Why did I receive a bill?

Accepted Answer

In most cases members will receive what is called a "balance  bill". The reason they received a bill in these cases was because the member was seen in the ER or pathology provider who is non-contracted and did not accept the initial payment for the IPA. The balance is not the member’s responsibility for these cases and claim must be forwarded to claims department for reprocessing. The member should only be charged applicable co-payment. 
Please note, that members who receive non-urgent/emergency services, will be responsible to charges incurred if they did not obtain prior authorization from the IPA.

Question 13

How long do referrals take to process?

Accepted Answer

Routine referrals take up to 5 business days to be processed.
Urgent referrals take up to 72 business hours to be processed. Emergency referrals take up to 24 hours to be processed.

Question 14

How do I submit an authorization?

Accepted Answer

To submit an authorization, you can:
 
Submit online via our Web Portal under “Authorizations.” If you do not have an account, please contact your Provider Relations Representative to set you up with a username and password.
 
Submit via fax. Please fax in a Treatment Authorization Request form (TAR) to 562-396-0403. For urgent request, please fax to (866) 574-0860.

Question 15

How do I modify an authorization?

Accepted Answer

To modify an authorization, you can:
 
Call our customer service line. Have the first name, last name, date of birth and what you are requesting to modify available at the time of the call.
Fax in modification request to (323)657-7055

Question 16

Why was the authorization denied?

Accepted Answer

An authorization may be denied for many reasons. Please contact our customer service for complete details.
 
If you disagree with the denial, please fax a copy of the original denial letter along with your supporting appeal information to 562-396-0403.

Question 17

What does deferred status mean?

Accepted Answer

An authorization is deferred for many reasons; please contact our customer service department, if your authorization is deferred.

Question 18

What services require authorizations?

Accepted Answer

Most services require an authorization. The only exceptions are well woman exams, any ER visits, and certain x-ray services referred to a contracted facility.

Question 19

Why was the claim payment not paid?

Accepted Answer

Sometimes, claims are not paid for various reasons. Please contact our claims department to get detailed reasons at 562-396-0403

Question 20

How do I search member claims, authorizations and eligibility?"

Accepted Answer

To search member eligibility and authorization, providers can use our Web Portal to check the status of a member. Providers can also call our Eligibility Dept at (562) 387-0403 and speak with a representative regarding member status. For claims and authorization status, please contact Customer Service at (562) 387-0403.

Question 21

I am experiencing a problem with WebPortal, who can I contact?"

Accepted Answer

For Web Portal help, please email to portal.help@pacipa.com

Question 22

I would like to contract with Pacific IPA.

Accepted Answer

Please fax your curriculum vitae, letter of interest, NPI and W-9 to our Contracting Department at 562-396-0403.

Question 23

How do I update my provider information?

Accepted Answer

To update your provider information, please fax the updated information to our Credentialing Department at (562) 396-0403 or email at credentialing.dept@pacipa.com

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