Referral and Authorizations

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A completed referral form is required from your physician to another in-network Jade Health Care Medical Group physician. An service authorization is a request for service that requires formal review by Jade Health Care Medical Group. Please see below for the updated information for the new MSO transition

Updated MSO Transition Functions

UM Authorizations
Request PRIOR to 09/01/2022: Please note, ALL authorizations issued by CCHP that expire after 09/01/2022, will still be valid. NMM will process and pay claims for authorizations that were approved by CCHP prior to transition if Date of Service (DOS) is ON or AFTER 9/1/2022. All requested authorizations submitted prior to 09/01/2022 will be available for view on the NMM Provider Portal.	All requested authorizations shall be submitted to NMM on or after 09/01/2022 The following are the processes for submitting referrals to NMM: Submit referrals via NMM Web Portal: NMM Provider Portal Providers > Provider-Portal • UM Routine Fax: (415) 523-9552 • UM Urgent Fax: (415) 523-9553

Claims Processing
Date of Service PRIOR to 09/01/2022 Claims with Date of Service PRIOR to 9/1/22 shall continue to be submitted to CCHP, and claims that were previously submitted to CCHP should continue to be reviewed and followed up with CCHP. All requested authorizations submitted prior to 09/01/2022 will be available for view on the NMM Provider Portal. In addition, status of claim shall be made available on the NMM Web Portal. All Provider Dispute Resolution (PDR) requests with DOS PRIOR to 09/01/22 shall be submitted to CCHP. CCHP Claims Status Inquiry: 1-888-755-7888 CCHP Payor ID: 94302	Date of Service ON or AFTER 09/01/2022 All claims with a Date of Service (DOS) ON or AFTER 9/1/22 shall be submitted to NMM. The following is the NMM Claims submission: NMM Provider Portal Office Ally ID: NMM07 Claims Mailing Address: 1600 Corporate Center Drive. Suite 106 Monterey Park, CA 91754 Please note, any service authorized by CCHP will be honored by NMM. Please ensure you include the CCHP authorization on all claims, when applicable. All Provider Dispute Resolution (PDR) requests with DOS ON or AFTER 09/01/22 shall be submitted to NMM.

Claims Processing

Date of Service PRIOR to 09/01/2022
Claims with Date of Service PRIOR to 9/1/22 shall continue to be submitted to CCHP, and claims that were previously submitted to CCHP should continue to be reviewed and followed up with CCHP. All requested authorizations submitted prior to 09/01/2022 will be available for view on the NMM Provider Portal.

In addition, status of claim shall be made available on the NMM Web Portal.
All Provider Dispute Resolution (PDR) requests with DOS PRIOR to 09/01/22 shall be submitted to CCHP.
CCHP Claims Status Inquiry: 1-888-755-7888
CCHP Payor ID: 94302

Date of Service ON or AFTER 09/01/2022
All claims with a Date of Service (DOS) ON or AFTER 9/1/22 shall be submitted to NMM.

The following is the NMM Claims submission:
NMM Provider Portal
Office Ally ID: NMM07
Claims Mailing Address:
1600 Corporate Center Drive. Suite 106
Monterey Park, CA 91754

Please note, any service authorized by CCHP will be honored by NMM. Please ensure you include the CCHP authorization on all claims, when applicable.

All Provider Dispute Resolution (PDR) requests with DOS ON or AFTER 09/01/22 shall be submitted to NMM.

Referral Form/Service Authorization Form (SAF) :

Prescription Drug Authorization Form (PDF) - CCHP Commercial & Covered CA Members
Medication Request Form (PDF) - CCHP Medicare Members Only
Consultation Referral Form (PDF)
Authorization Request Form – Jade (PDF)