Electronic claim submission is the preferred method for submitting your claims to Affinity Medical Group.
Affinity Medical Group remains committed to maintaining the highest standards of quality and efficiency among its practices. Electronic claims submission represents a significant opportunity for practices and the Medical Group to improve productivity and efficiency. Benefits of electronic claims submission include:
In the interest of greater efficiency, Affinity Medical Group strongly encourages all of its physicians to participate in electronic claims submission.
Affinity receives claims electronically through three clearinghouses:
Clearinghouse (Submitter Number)
For help establishing electronic claim submission, contact Affinity Customer Service at (800) 615-0261.
There are special requirements for the following types of bills.
Affinity is secondary:
Upon receipt of payment from the primary carrier, a claim should be submitted to Affinity along with a copy of the EOB from the primary carrier. Affinity will process the claim and pay the lesser of the remaining member responsibility or the Affinity contracted allowable for the service. If service falls under the cap, charges will be capitated accordingly and the member cannot be billed.
Affinity is both the primary and secondary carrier:
The following requirements must be met to minimize the potential for rejection of claims, delays in processing, and/or identification of problems.
Affinity Medical Group
PO BOX 425
Newark, CA 94560-0425
Submit any additional pertinent documentation related to the claim.
Timely Submission is required
Claims should be submitted within the timeframe specified in your contract. Most contracts require that claims be submitted within ninety (90) days from the date of service. Your medical group accepts no obligation to pay claims received after the timeframe in your contract.
Coordination of Benefits
An exception to the timeframe includes Coordination of Benefits (COB) claims where collection from a primary source is required prior to billing your medical group. In these cases, submission is required ninety (90) days from the date payment is received from the other carrier.
Health Plan Payments (claims that are the responsibility of the Health Plan)
Claims requiring health plan payment should be forwarded directly to the appropriate health plan. Claims that are sent to Affinity inadvertently will be redirected to the health plan or to the party responsible for payment.
The Knox-Keene Act, California Health and Safety Code Section 1340 et. seq. specifically prohibits the practice commonly known as “Balance Billing” where a Contracted Provider attempts to collect the outstanding balance that is not paid by the Plan for services rendered to the member.