605 E. Badillo St., #300
Covina, CA 91723
P.O. Box 371330
Reseda, CA 91337
What are the requirements for a completed claim?
A completed claim must be submitted on a CMS-1500 form for professional services and a CMS-1450 form for hospital/facility services and must have the following information:
Insured’s ID number
Patient’s birth date
Diagnosis or nature of Illness or Injury (ICD-9CM code, up to four codes)
Prior authorization number
Date(s) of service
Place of service
Procedures, services or supplies (CPT/HCPCS/NDC Code/Modifier)
Charges for each service billed
Days of units
Federal tax ID number
Provider license or UPIN number
Patient’s account number
Signature of physician or supplier, including degrees or credentials (if billed on paper)
Physician billing name, address, zip code
What timeframe do I have to submit a claim if I’m not contracted with you?
We follow the AB1455 requirements. Claims must be received within 180 days of date of service to be considered timely for non-contracted providers.
How do I appeal a claims payment, contested claim or denial?
If you dispute any denial, claims payment, or contested claim, please submit in writing your provider dispute to:
605 E. Badillo St., #300
Covina, CA 91723
P.O. Box 31330
Reseda, CA 91337
Your dispute can be submitted by a letter or by a provider dispute form. To obtain a provider dispute form, please contact (626) 974-0440.
Your dispute must contain the following information:
Provider’s identification number
Provider contract information
A clear identification of the disputed item
Date of service
Please include a clear explanation of the basis upon which you believe the payment amount, contested item, denial or other action is incorrect. Disputes must be submitted and received within 365 days from the date of the last transaction.
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule affords members the right to receive a notice that describes how health information may be used and disclosed and how to get access to this information. Regal Medical Group (RMG) is required to send a notice ("Notice of Privacy Practices") to members of our insured Health and Long Term Care plans.
RMG welcomes you to their website. All information that is collected on our website is done on a voluntary basis. All non-public personal information that you provide via our website will be used strictly for the purpose stated on the page where it is collected. RMG will not sell, license, transmit or disclose this information outside of RMG or our affiliated companies unless (1) required or permitted by law, (2) expressly authorized by you, or (3) necessary to enable RMG contractors or agents to perform certain functions for us. With all disclosures, we will disclose information consistent with applicable law and regulations and we will require the recipient to protect the information and use it only for the intended purpose.
"Personal Information" is defined as data that is unique to an individual, for example: name, address, member id, date of birth, or telephone number. There may be occasions where we may request personal information on our website in order to provide services or respond to your questions.
Feedback and questions are always welcome on our website. We have provided e-mail boxes for that purpose. Your feedback and questions will be shared with our customer service representatives and those employees most capable of addressing your feedback and questions.
Please note e-mail, like most, if not all, non-encrypted Internet e-mail communications, may be accessed and viewed by other Internet users, without your knowledge and permission, while in transit to us. For that reason, to protect your privacy, please do not use e-mail to communicate information to us that you consider confidential. If you wish, you may contact us instead via non-cellular telephone at the numbers provided on our Contact Us page or Member Services at 866-654-3471.
We have made some locations on our website secure, so you can exchange non-public personal information with us. You will be provided appropriate instructions at each of these locations.
Linking to Other Sites
RMG's website may provide links to other websites, that are not owned or maintained by RMG, that we think might be useful or of interest to you. These other websites will open in a separate browser window. We are not responsible for the privacy practices used by other websites, the content, or accuracy of the other websites. These links to other non-RMG websites do not constitute or imply endorsement by RMG of these websites, any products or services described on these sites, or of any material contained in them.
RMG has adopted and adheres to stringent security standards designed to protect non-public personal information at regalmed.com against accidental or unauthorized access or disclosure. Among the safeguards that RMG has developed for this site are administrative, physical and technical barriers that together form a protective firewall around the information stored at this site. We periodically subject our site to simulated intrusion tests and have developed comprehensive disaster recovery plans.
Changes to this Statement
RMG may change this Statement from time to time without notice. This Statement is not intended to and does not create any contractual or other legal rights in or on behalf of any party.
All information provided on this web is "AS IS" without warranty of any kind, either express or implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Some jurisdictions do not allow for the exclusion of implied warranties, so the exclusion above may not apply to you. The data set forth herein is for informational purposes only, and no warranty is made that the information is error-free. Please note that once you leave this site, either by using a link we may have provided for your convenience or by specifying your own destination, RMG accepts no responsibility for the content, products and/or service provided at these non-RMG locations. RMG does not control, endorse, promote, or have any affiliation with any other website unless expressly stated herein.
RMG will not be held liable to any party for any direct, indirect, special, or other consequential damages arising from any use of this website, or any linked website, including, without limitation, any loss of profits, business interruption, loss of programs or data on your equipment, or otherwise, even if we are expressly advised of the possibility or likelihood of such damages.
Changes to This Website
Information may be changed or updated without notice. RMG has no obligation to update information presented on this website, so information contained herein may be out of date at any given point in time. RMG may also make improvements and/or changes in the services and/or programs described in this information at any time without notice.