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Frequently Asked Questions

Who is CFMC?
CFMC is a Preferred Provider Network (PPO). The CFMC network is available to TPAs, insurance carriers and other payors looking for quality, affordable health care cost.

Is the CFMC network national?
The CFMC network serves members located in California from as far north as Humboldt County to as far south as San Diego County. However, CFMC does have a relationship with a National PPO allowing member access to providers on a national level.

What types of services does CFMC offer to self-funded health plans, insurance companies and TPAs?
In addition to the CFMC network, our services include flexible claims repricing; traditional utilization review and precertification review and large claims medical case management.

How do I find a CFMC network provider?
The most convenient way to find a doctor, hospital or other health care service provider participating in the CFMC network is by searching our online directory at www.cfmcnet.org. The directory is available 24 hours a day, 7 days a week. The directory includes the most detailed provider information available and is updated daily. You can also call directly at 800-324-7341 for assistance in locating a provider.

Why should I use a CFMC network provider?
Under your group health plan, you are free to decide whether to use a CFMC provider, but there are many advantages to doing so:

  • They will file health insurance claims for you.
  • They will collect only patient co-payments, not the full amount of the charges.
  • Their services will most likely cost you less because of our contract rates with them, and in some cases, because your health plan pays higher benefits for using network providers.

Can I nominate a provider for the CFMC network?
Yes, please use the nominate a provider option on the CFMC website. If you are a patient, you may complete the online Provider Nomination Form.

How does CFMC channel patients to its network?
We encourage strong benefit plans that direct or channel participants to CFMC Network providers within state-specific guidelines for directing care. Increasing network penetration means health care cost savings for payors and patients. Our electronic directory is the most convenient way for members to locate a provider. Other channeling tools can include tools provided by your administrator such as ID cards, paycheck stuffers and early identification of high-cost members through early medical assessment.

What is a PPO Network?
The Preferred Provider Organization (PPO) is a network of participating hospitals, physicians, and ancillary providers who have agreed to accept discounted fees and agree to physician peer review and utilization management as a means to maintain quality care. The PPO emphasizes patient choice, allowing access to a broad selection of providers who agree to deliver care in a cost-effective manner.

What is a EPO Network?
The Exclusive Provider Organization (EPO) is a network of participating hospitals, physicians, and ancillary providers that places greater emphasis on health care management. Patient access is limited to EPO providers. A nurse triage model is utilized to monitor access to services, and providers must obtain approval based on predetermined criteria before services are rendered. This efficient and tightly managed care program has saved our clients as much as 20% over other models. There is no need to select a primary care physician to serve as the gatekeeper. Patients are free to select any provider in the EPO panel for their health care needs.

What is a WCO Network?
The Workers' Compensation Network (WCO) is designed to assist the employee in returning to work while controlling medical treatment costs. Through our network of workers' compensation hospitals, physicians, ancillary providers, and HCO time away from work is minimized and employer costs are contained. Costs are further controlled through excellent hospital contracts, discount off the fee schedule, and through physician peer review and utilization management.

How many PPO providers are contracted?

 

CFMC Provider Network PPO
PCP's 10,100
Specialist 10,800
Hospital 251
Ancillary 5553

 

How can I get more information about the CFMC Network?
Please contact us via this website or call us at 800-334-7341.

 

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California Foundation for Medical Care
Corporate Office
3993 Jurupa Avenue
Riverside, CA 92506
800-334-7341     Fax: 951-686-1692

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Contact Us
California Foundation for Medical Care
Corporate Office
3993 Jurupa Avenue
Riverside, CA 92506
800-334-7341     Fax: 951-686-1692