County of Ventura
Emergency Medical Services Fund & Uncompensated Care Program

VCMA Physician Education Subcontractor
$1,022,391 was paid out to private physicians in Ventura County for Fiscal Year date of services 7/1/04 – 6/30/05 for Emergency Room services and OB/Pediatric in-office care. Approximately $8,500,00 has been paid to Ventura County physicians since the program was reinstated July 1999 thru June 2005. Claims are paid at a maximum of 50% of billed charges (may be less, dependent upon available funds and total of claims submissions). Maximum allowable charges: 200% of Medicare.

SCHEDULE FOR SUBMISSION OF CLAIMS
Claims must be submitted no earlier than 90 days from the date of service, nor later than 120 days after initial billed date. Claims submitted after 120 days will be denied.

It is encouraged to have claims submitted at the earliest possible date; all claims are screened for Medi-Cal eligibility on a monthly basis. If patient is deemed to have Medi-Cal active eligibility retroactive to the time of service, claim will be returned to physician with information for resubmission to Medi-Cal.

Claims administrator releases payments quarterly.

PLEASE NOTE the following important items on the claim Data Form:
General Info; Items 1. thru 8. are to be as complete as possible. If any part of patient information being requested is missing, mark question “unknown”; select “Non-Contract Emergency” for all emergency care.

OBG & Pediatric in office care; Items 19. thru 24. must be completed in entirety, or claim will be rejected (does not require referral from ER).

Service Beyond 48 hours; Item 19.4 must provide information regarding the initial date and provider of ER encounter to be eligible for reimbursement of follow-up care beyond 48 hours (up to 60 days) and/or outside of hospital setting (ER or discharge referral).

Do Not Submit Duplicate Claims: A processing fee of $5.50 will be deducted from final claim payment, if duplicate claim is submitted.

Questions concerning submission deadlines, service eligibility or denial appeals, or to request forms, call VCMA 805/484-6822. Status of claims after submission, call American Insurance Administrators 800/303-5242 or 310/390-7900.