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Claims Administration

The Claims Department processes medical bills submitted by participating physicians, as well as other medical providers. All claims are entered (or when available imported electronically) into our core system, then adjudicated according to contractual agreements and prior authorization requirements.

IPA Claims Contact

Claims Department   (408) 937-3620   FAX: (408) 937-3634

Submitting Claims   

Claims may be submitted either by mail or electronically. If you are submitting a claim which requires inclusion of medical notes, surgical notes, explanation of benefits, or forms, please send a paper claim instead of an electronic claim.  This will ensure the claim and the appropriate attachments are received by the Claims Department.

**Contracted providers should submit claims 90 days from the date of service.  Non-contracted providers should submit claims 180 days from the date of service.  Failure to do so will result in claims denying for timely filing.

Paper/Mail Claim Submission

Mail claims (including all appropriate attachments) to:

Physicians Medical Group of San Jose
Claims Department
75 East Santa Clara Street, Suite 950
San Jose, CA 95113

Attn:  Specify Commercial or Medi-Cal/Healthy Families/Healthy Kids

Electronic Claim Submission

Electronic claim submission saves postage, paper, human resources, and decreases the overall processing time. For smooth uploading of electronic claims, be sure the patient’s name, Date of Birth, and Insurance ID are entered exactly the same as they are shown on the member’s Health Plan identification card.


Claim Status and Payment Information

For contracted providers claims submitted and processed by the IPA may be viewed through the provider’s login application.  Please allow a minimum of 2 weeks for claims to appear in the system after mail submission.  If you are a contracted provider and have not obtained a login please call Provider Services at 408-937-3612.  For non-contracted provider please call the Claims Department at (408) 937-3620.