Managed care
Prospect Medical Group, INC.
Prospect Medical Group, INC. was paid $209K by Medicaid between Jan 2018 and Nov 2021, across 61 billing codes. Its largest line is U0003, Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r — 66% of everything it billed.
33Billing provider infoPROSPECT MEDICAL GROUP, INC.
ORANGE, CA 92868
ORANGE, CA 92868
33aNPI1578602108assigned 02/06/2007
33bProvider typeHealth Maintenance Organization
28Total paid$209K
24GClaims14,601
24DCodes billed61
24AFirst – last monthJan 2018 – Nov 2021
Compared with peers
Next to other Health Maintenance Organization providers in California
Rank by total paid#54 of 151
Median peer was paid$59K
This provider vs. median3.5×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 4,880 | $22K | |
| 2019 | 121 | $1K | |
| 2020 | 2,559 | $86K | |
| 2021 | 7,041 | $100K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 66% | 1,607 | 1,207 | $138K |
| A0429 | Emergency ambulance ride, basic life supportAmbulance service, basic life support, emergency transport (bls-emergency) | 3.4% | 55 | 46 | $7K |
| 80061 | Lipid panel | 3.1% | 995 | 991 | $6K |
| 84443 | Thyroid stimulating hormone (TSH) | 2.6% | 942 | 938 | $6K |
| 99348 | 2.6% | 195 | 195 | $5K | |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2.4% | 229 | 186 | $5K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 2.2% | 1,184 | 1,052 | $5K |
| 80053 | Comprehensive metabolic panel | 2.1% | 1,167 | 1,132 | $4K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 1.9% | 1,329 | 1,257 | $4K |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 1.9% | 564 | 564 | $4K |
| 83036 | Hemoglobin; glycosylated (A1C) | 1.8% | 912 | 903 | $4K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 1.6% | 67 | 64 | $3K |
49 more codes
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r | 1.1% | 27 | $2K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 1.1% | 212 | $2K |
| 59425 | <1% | 22 | $2K | |
| 96156 | <1% | 70 | $2K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 200 | $1K |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 210 | $1K |
| 81001 | <1% | 422 | $707.86 | |
| 82274 | <1% | 55 | $685.97 | |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | <1% | 12 | $591.36 |
| 82043 | <1% | 182 | $394.50 | |
| 84153 | <1% | 43 | $389.07 | |
| Q3014 | Telehealth originating site facility fee | <1% | 16 | $367.04 |
| 82570 | <1% | 182 | $356.10 | |
| 84481 | <1% | 35 | $352.30 | |
| 82607 | <1% | 64 | $291.98 | |
| A0425 | Ground mileage, per statute mile | <1% | 154 | $284.33 |
| 99214 | Doctor's office visit, returning patient (more involved) | <1% | 40 | $274.40 |
| 86592 | <1% | 188 | $238.50 | |
| 84439 | <1% | 97 | $221.03 | |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 50 | $211.85 |
| 81003 | <1% | 347 | $172.47 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 31 | $160.50 |
| 96127 | <1% | 49 | $158.73 | |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 78 | $143.92 |
| 36415 | Collection of venous blood by venipuncture | <1% | 419 | $141.99 |
| 92551 | <1% | 96 | $131.59 | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 49 | $131.55 |
| 99000 | <1% | 133 | $127.05 | |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | <1% | 616 | $81.25 |
| 80076 | <1% | 26 | $70.18 | |
| 92015 | Determination of refractive state | <1% | 12 | $55.51 |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 121 | $54.83 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 42 | $49.06 |
| 99173 | <1% | 161 | $47.35 | |
| 85018 | <1% | 107 | $43.69 | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 70 | $43.52 |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | <1% | 116 | $40.52 |
| 81002 | <1% | 58 | $25.80 | |
| 88175 | Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer | <1% | 14 | $23.50 |
| 90686 | <1% | 70 | $23.49 | |
| 90658 | <1% | 55 | $22.70 | |
| 99199 | Unlisted special service, procedure or report | 0% | 194 | $0.00 |
| 90461 | 0% | 14 | $0.00 | |
| 90715 | 0% | 13 | $0.00 | |
| 90734 | 0% | 43 | $0.00 | |
| H1003 | Prenatal care, at-risk enhanced service; education | 0% | 15 | $0.00 |
| 90649 | 0% | 30 | $0.00 | |
| 81000 | 0% | 64 | $0.00 | |
| 85027 | 0% | 31 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialKAM, LILY (CFO)
| Provider | Location | Paid |
|---|---|---|
| Prospect Professional Care Medical Group, INC. | Santa Ana, CA | $10K |
| Prospect Healthsource Medical Group INC | Orange, CA | $571.69 |
| Nuestra Familia Medical Group INC | Orange, CA | $71.72 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.