RMC

Provider Resources

In an ongoing effort to provide quality customer service to our providers, Riverside Medical Clinic (RMC) is pleased to provide you with access to our new claims inquiry website called “Plan Link” – accessible at the following link: www.planlink.riversidemedicalclinic.com 

Provider Disputes/Appeals

The goal of Riverside Medical Clinic (RMC) is to provide our contracted providers, physicians and other affiliated groups with information needed to assist them with the Provider Dispute Resolution Process in accordance with Title 28 CCR Section 1300.71, or AB1455. Should you disagree with a decision made by RMC regarding the payment or denial of a claim, or RMC’s request for reimbursement of an overpayment, please go to one of the following links for direction:

 How to file a provider dispute *

 General Claim Requirements Updates 2017*

 Provider Dispute Forms *

 Claims Re-submission Form * (to be used only for submitting previously requested documentation)

 National Provider Identification (NPI) Fax Form *  This form is to be used when the provider has not supplied RMC with their NPI number. If you have not, please fill this form out and fax back to our contracting department at the number listed on the form.

 *Requires Adobe Reader© – click to download reader software.

If you are a contracted provider of Riverside Medical Clinic, you may request to access your claims information by faxing the form below* to: (951) 274-0321.

 Request for a Provider Account and Password*

Once the form is received, RMC will provide a username and password so that you may access a secure site housing specific claims received from your office, as well as claims that have been processed and closed. Once the form has been received, a letter will be mailed to you containing your password and instructions for logging on to your site.

Contracted Provider Reimbursement Information

You may also contact one of our customer service representatives at (951) 782-3060 and they will be happy to walk you through the process.

*Requires Adobe Reader© – click to download reader software.

Contracted Provider Reimbursement Information

*Disclaimer* By clicking any of the following links, you will be leaving Riverside Medical Clinic’s web site and be re-directed to https://med.noridianmedicare.com/. Although RMC
believes this site will be beneficial for you when inquiring on the Medicare Fee schedule, when reviewing the various Medicare Billing guides and resource material, RMC does not take responsibility for the accuracy of it’s contents or the information contained on this web site. You will have access to the following information.

Main Medicare Web Site

Medicare Fee Schedule

Centers for Medicare and Medicaid Services (CMS)

Instructions for looking up Provider Fee Schedule

In accordance with your Provider Services Agreement, you will be reimbursed at a percentage of the current Medicare Allowable for your geographic location. All claims are processed in accordance with State and Federal regulations.

CMS Fraud, Waste and Abuse Training

Health Industry Collaboratoin Effort, Inc (ICE) has provided a Fraud, Waste, and Abuse training module with instructions on their website, along with other helpful documents. Please click here to be redirected to this page.

Click here for Medicare parts C & D Fraud, Waste and Abuse Training and General Compliance Training.

You may also contact one of our customer service representatives at (951) 782-3060 and they will be happy to walk you through the process.

Utilization Management Questions and Concerns

a. If you have questions or concerns regarding Utilization Management (UM) during normal business hours (8:30am – 5:30pm), please contact a UM Team Member to assist you at 800-700-6646 (collect calls are accepted).

b. If you would like to discuss a review determination with an Attending Physician and/or Healthcare Professional Reviewer, please contact 951-782-3076 or 800-700-6646.

c. Standing referrals are available when a members condition or disease involves a complicated treatment regimen that involves ongoing monitoring to ensure adherence. It also applies to members who are currently being treated for an acute or serious chronic condition for up to ninety (90) days or high risk pregnancy.