FAQs

For Member:
What is an IPA?
Who can join an IPA?
How do I become an Allied Pacific IPA member?
Where is Allied Pacific IPA member service center located at?
What are the hours of operation for Allied Pacific IPA?
What do I do in case of a medical emergency?
What do I do if I would like to see a Physician at after work but my family doctor's office is already closed?
How do I choose or change my family doctor?
What is my copay?
What is an authorization?
What happens when my authorization gets denied?
Why did I receive a bill?
I just turned 65 and I have questions about Medicare.
Does Allied Pacific IPA have any contracted Medicare Plans?

For Providers:
How long do referrals take to process?
How do I submit an authorization?
How do I modify an authorization?
Why was the authorization denied?
What does deferred status mean?
What services require authorizations?
Why was the claim payment not paid?
How do I search member claims, authorizations and eligibility?
I am experiencing a problem with WebPortal, who can I contact?
I would like to contract with Allied Pacific IPA.
How do I update my provider information?


 

What is an IPA?

IPA or 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.

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Who can join an IPA?


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

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How do I become an Allied Pacific member?

To join Allied Pacific IPA, Please refer to (How to join Allied Pacific IPA) page. For more inquiries, please call 626-282-0288 and speak with one of our customer service representatives.

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Where is Allied Pacific member service center located at?

Allied Pacific IPA continue to provide quality service to members. The member service center is located at 568 W. Garvey Ave, Monterey Park, CA 91754. We welcome any walk-in members Monday to Friday 9am-5pm. For more inquiries, please call 626-282-0288.

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What are the hours of operation for Allied Pacific IPA?

Member service center: Monday to Friday from 9AM to 5PM.
Operation: Monday to Friday from 9AM to 5PM.

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What do I do in case of a medical emergency?

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.

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

Allied Pacific offers several locations of After Hour Care Centers throughout San Gabriel Valley to service our members in medical needs. For location and hours of operations, please click here.

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How do I choose or change my family doctor?

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

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What is my copay?

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

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What is an authorization?

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

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What happens when my authorization gets denied?

An authorization may be denied for many reasons. Please contact our customer service 626-282-0288 for complete details.

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Why did I receive a bill?

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 dept for reprocessing. The member should only be charged applicable copayment. 

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.

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I just turned 65 and I have questions about Medicare.


Congratulations on reaching the golden age of 65! As you turn 65 there are a lot of decisions to make regarding your healthcare needs. Allied Pacific of California IPA has held educational seminars throughout San Gabriel Valley to help you understand Medicare better. Please contact 626-282-0288 for more details.


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Does APC have any contracted Medicare Plans?

Allied Pacific IPA of California is contracted with these MAPD plans.

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How long do referrals take to process?

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.

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How do I submit an authorization?
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 626-943-6367. For urgent request, please fax to 626-943-6387.

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How do I modify an authorization?
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 626-943-6386.

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Why was the authorization denied?

An authorization may be denied for many reasons. Please contact our customer service for complete details.
If you disagree with the denial, please submit a copy of the original denial letter along with your supporting appeal information to 626-943-6386.

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What does deferred status mean?

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

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What services require authorizations?

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.

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Why was the claim payment not paid?

Sometimes, claims are not paid for various reasons. Please contact our claims dept to get detailed reasons at 626-943-6293 / 626-282-0288.

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How do I search member claims, authorizations and eligibility?

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 626-943-6179 and speak with a representative regarding member status. For claims and authorization status, please contact Customer Service at 626-282-0288.

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

For Web Portal help, please email to portal.help@nmm.cc / pportal.inquiries@nmm.cc or contact 626-943-6146.

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I would like to contract with Allied Pacific IPA.

Please fax your curriculum vitae, letter of interest, NPI and W-9 to our Contracting Dept at 626-943-6373.

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How do I update my provider information?

To update your provider information, please fax the updated information to our Credentialing Dept at 626-943-6372 or email to credentialing.dept@nmm.cc.

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