The Finance Department
Responsible for all facets of financial reporting and data generation, timely payment of capitation, and claims. It is Care1st Health Plan’s objective to pay all capitation by the 6th of the month and send all electronic financial data including but not limited to detail claims data, pharmacy data and capitation data by the 8th of the month. Care1st quarterly and annual risk pool reports plus required data are sent to each IPA/MSO before the deadline set by regulatory provisions.

The Claims Department
The Claims department systematically establishes goals and standards to improve the effectiveness of claims processing. Responsible for timely and proper payment of all claims.

The Claims Compliance Department
Responsible for due diligence audits of IPAs. It is Care1st Health Plan’s commitment to ensure that all IPAs are in compliance with the regulatory requirements. Care1st also has on-site monitoring team to assist its IPAs in improving their claims payment processing, policy and procedures, and the full compliance of the requirements.

The Encounter Data Department
Responsible for processing Encounters submitted by Medical Groups/IPAs, and physician offices. The department works with each IPA and their designated MSO to ensure data is submitted to LA Care in a timely manner and compliance benchmarks are met.