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DIRECT REFERRAL FORM FAX TO: 8008742093 Please call the specialist/ancillary provider listed and make an appointment. PATIENT TAKE THIS FORM WITH YOU TO THE APPOINTMENT AND GIVE IT TO THE OFFICE STAFF.

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For claim filing requirements or status inquiries, you may contact Preferred IPA by calling: (800) 874-2091. The claims inquiry telephone line is open Monday through Friday from 9 a.m. – 4 p.m. The claims inquiry telephone line will be closed on Federal Holidays.

Darin W. Montgomery - Director Healthcare Services - PREFERRED IPA OF CALIFORNIA, A PROFESSIONAL MEDICAL CORPORATION | LinkedIn.

â—¦ Timely submission - Encounter data must be received by Preferred IPA within 30 days or less from the date of service. â—¦ Acceptable format - Encounter data must be received on a complete CMS 1500 form or electronically through Office Ally.

PLEASE CALL 818-265-0800 x200 TO VERIFY CONTRACTED LABORATORY PROVIDER.

All outpatient services (except for provider-administered medication for chemotherapy or transplant immunosuppression) should be submitted via fax to CCIPA at (818) 340-1785 or you may contact CCIPA directly at (866) 423-0060.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232