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County of Ventura
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Date of Service |
Submission Dates |
January 2006 February 2006 March 2006 |
4/1-5/31/06 5/1-6/30/06 6/1-7/31/06 |
April 2006 May 2006 June 2006 |
7/1-8/31/06 8/1-9/30/06 9/1-10/31/06 |
July 2006 August 2006 September 2006 |
10/1-11/30/06 11/1-12/31/06 12/01/06-01/31/07 |
October 2006 November 2006 December 2006 |
1/1-2/28/07 2/1-3/31/07 3/1-4/30/07 |
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.

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