Payment Information
You may check your claim status online by registering to have access to our web portal:
- • Web Portal – Please visit https://connect.familychoiceportal.com
Contracted Providers are to be paid at their contracted rates. For non-contracted providers, please see the below payment methodology:
Commercial Members
Services rendered to a Commercial member are paid at the reasonable and customary value of 125% of Medicare. AB72– Pursuant to CA H.&S Code and CIC, claims are to be paid at the greater of- average contract reimbursement rate or 125% of Medicare.
Patients are only responsible for in-network cost-sharing and may not be balanced billed for any other amounts.
For Non-Emergency Claims
1. Contracted Paid/Denied Claims:
Under the Knox Keene Act, an eligible member to whom services were provided shall not be liable for any portion of
the bill, except for applicable cost share, which may include deductible, co-insurance and/or copayments. The
contracted provider should not bill the member or attempt to collect against the member, unless the member was not
eligible at the time the services were rendered or non-emergency services were not authorized and/or directed by
the participating medical group or primary care physician. Pursuant to the Knox Keene Act of the State of
California, the enrollee to whom prior approved services were provided is not liable for any portion of the bill,
except for co-payments, deductibles, other cost sharing components, or non-covered benefits as defined in the
enrollee’s Evidence of Coverage documents. In the event the member appeared eligible no more than 72 hours prior
to services being rendered and an authorization or eligibility is provided that the specific provider relied upon
to render services and the member later appears ineligible on date of services, Knox-Keene requires that the
provider and member be held harmless and you cannot recover payment.
2. Non-Contracted Claims
Paid Claims:
For dates of services on or after July 1, 2017; non-contracted providers may NOT
balance bill a member for non-emergency services when covered services are rendered in a Participating Facility.
UnitedHealthcare has many participating specialists and regional facilities available to the IPA. In the event the
IPA elects to use a non-participating Facility and the IPA does not enter into a Letter of Agreement that protects
the member, all authorized services for non-emergency providers must be paid at billed charges minus the member’s
applicable cost-sharing. Denied Claims: You may file a written appeal to the IPA with a clear & concise
reason for questioning/disputing the denial decision.
The below link may be utilized to review Medicare rates for the CPT code(s) billed:
Fee Schedules – JE Part B – Noridian
Medi-Cal Members
Services rendered to a Medi-Cal member are paid at Medi-Cal rates. The Medi-Cal rates are updated by the 15th of
each month.
The below link may be utilized to review the current Medi-Cal rates for the CPT code(s) billed:
Medi-Cal Rates | Medi-Cal Providers
Medicare Members
Services rendered to a Medicare member are paid according to Medicare guidelines at Medicare rates and specific
regulatory calculators for the geographical locality.
The below link may be utilized to review Medicare rates for the CPT code(s) billed:
Fee Schedules – JE Part B – Noridian
For any inquiries, please contact Customer Service, by calling:
Monday – Friday 8:00am to 5:00pm and for CalOptima Members- 8:00am to 6:00pm
We are
closed on all major holidays.
(800) 611-0111
Family Choice Medical Group