Health Maintenance Organization In Walnut California

NPI list of 2 health maintenance organization registered providers with a business address in Walnut, CA, all registered as organizations. (1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model.

NPI Name Type Taxonomy Address Medicare PECOS
1821322082BAXCO PHARMACEUTICAL, INC.OrganizationHealth Maintenance Organization205 LEMON CREEK DR
WALNUT, CA 91789
(909) 595-0826
Non-Participating ProviderNO
1851926299ADVANCED MSOOrganizationHealth Maintenance Organization18800 AMAR RD STE B2
WALNUT, CA 91789
(888) 998-9833
Non-Participating ProviderNO

Medicare Participation

  • Participating providers are registered with Medicare and accept claims assignment. Taking claims assignment means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or co-payment amount for a visit or service.
  • Non-Participating providers do not agree to take Medicare claims assignment. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.
  • Opt-out providers signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so.

What is PECOS?

PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals eligible to order or refer healthcare services for Medicare patients.