Finance & Claims Department

We Have a Strong Economic Policy

At Care1st, this team is 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 within 10 days following plan's receipt of payment from L.A. Care, and send all electronic financial data including (but not limited to) detail claims data, pharmacy data and capitation data by the 10th 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.

Our Claims Department

The Claims department regularly establishes clearly defined goals and standards to improve the effectiveness of our claims processing. This group is responsible for timely and proper payment of all claims.

  • CLAIMS SUBMISSION:
    Regular/New claims
    Care1st Health Plan
    Mail Stop: CL001
    601 Potrero Grande Dr.
    Monterey Park, CA 91755
  • Misdirected Claims
    Care1st Health Plan
    Mail Stop: CL004
    601 Potrero Grande Dr.
    Monterey Park, CA 91755

The Claims Compliance Department

Responsible for due diligence audits of IPAs, the Claims Compliance Department enforces our commitment to ensure all IPAs are in compliance with the regulatory requirements. Care1st also has an 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 all encounters submitted by Medical Groups/IPAs, and physician offices, this department works with each IPA and their designated MSO to ensure data is submitted to L.A. Care in a timely manner and that compliance benchmarks are being met.

Got Questions?

Please call 1-323-889-5220 if you require any additional information or clarification.