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IEHP Notice of Non-Discrimination

ights laws. IEHP does not unlawfully discriminate, exclude people, or treat them differently because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation. IEHP provides: Free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats)   Free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact IEHP Member Services between 8am-5pm (PST), by calling 1-800-440-IEHP (4347), 7 days a week, including holidays. If you cannot hear or speak well, please call 1-800-718-4347. Upon request, this document can be made available to you in braille, large print, audiocassette, or electronic form. To obtain a copy in one of these alternative formats, please call or write to: Inland Empire Health Plan 10801 6th St., Rancho Cucamonga, CA 91730-5987 1-800-440-4347 (TTY: 1-800-718-4347/California Relay 711) How to file a grievance If you believe that IEHP has failed to provide these services or unlawfully discriminated in another way on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you can file a grievance with IEHP’s Civil Rights Coordinator. You can file a grievance by phone, in writing, in person, or electronically: By phone: Contact IEHP’s Civil Rights Coordinator between 8am-5pm (PST), by calling 1- 800-440-4347. Or, if you cannot hear or speak well, please call TTY: 1-800-718-4347/California Relay 711. In writing: Fill out a complaint form or write a letter and send it to - IEHP’s Civil Rights Coordinator, 10801 6th St., Rancho Cucamonga, CA 91730-5987 In person: Visit your doctor’s office or IEHP and say you want to file a grievance. Electronically: File a grievance online. Office of Civil Rights - California Department of Health Care Services You can also file a civil rights complaint with the California Department of Health Care Services, Office of Civil Rights by phone, in writing, or electronically: By phone: Call (916) 440-7370. If you cannot speak or hear well, please call 711 (Telecommunications Relay Service). In writing: Fill out a complaint form or send a letter to - Deputy Director, Office of Civil Rights Department of Health Care Services Office of Civil Rights, P.O. Box 997413, MS 0009 Sacramento, CA 95899-7413 Electronically: Send an email to CivilRights@dhcs.ca.gov. Office of Civil Rights - U.S. Department of Health and Human Services If you believe you have been discriminated against on the basis of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by phone, in writing, or electronically: By phone: Call 1-800-368-1019. If you cannot speak or hear well, please call TTY/TDD 1-800- 537-7697. In writing: Fill out a complaint form or send a letter to - U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 Electronically: Visit the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf LANGUAGE ASSISTANCE English ATTENTION: If you need help in your language call 1-800-440-4347 (TTY: 1-800-718-4347). Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 1-800-440-4347 (TTY: 1-800-718-4347). These services are free of charge. الشعار بالعربي ة (Arabic) يُر جى الانتباه:ى إذا احتجت إلى المساعدة بلغتك، فاتصل ب 1-800-440-4347 (TTY: 1-800-718-4347) .ى تتوفر ا ً أيض المساعدات والخدمات للأشخاص ذوي الإعاقة، مث ى ل المستندات المكتوبة بطريقة بريل والخ ى ط الكب ري.ى اتصل ب 1-800-440-4347 (TTY: 1-800-718-4347) . هذه الخدمات مجانيةى. Հայերեն պիտակ (Armenian) ՈՒՇԱԴՐՈՒԹՅՈՒՆ: Եթե Ձեզ օգնություն է հարկավոր Ձեր լեզվով, զանգահարեք 1-800-440-4347 (TTY: 1-800-718-4347)։ Կան նաև օժանդակ միջոցներ ու ծառայություններ հաշմանդամություն ունեցող անձանց համար, օրինակ` Բրայլի գրատիպով ու խոշորատառ տպագրված նյութեր։ Զանգահարեք 1-800-440-4347 (TTY: 1-800-718-4347)։ Այդ ծառայություններն անվճար են։ ឃ្លាសម្គាល់ជាភាសាខ្មែរ (Cambodian) ចំណំ៖ ប ើអ្នក ត្រូវ ការជំនួយ ជាភាសា រ ស់អ្នក សូម ទូរស័ព្ទបៅបេខ 1-800-440-4347 (TTY: 1-800-718-4347)។ ជំនួយ និង បសវាកមម សត្ា ់ ជនព្ិការ ដូចជាឯកសារសរបសរជាអ្កសរផុស សត្ា ់ជនព្ិការភ្ននក ឬឯកសារសរបសរជាអ្កសរព្ុមពធំ ក៏អាចរកបានផងភ្ដរ។ ទូរស័ព្ទមកបេខ 1-800-440-4347 (TTY: 1-800-718-4347)។ បសវាកមមទំងបនេះមិនគិរថ្លៃប ើយ។ 简体中文标语(Chinese) 请注意:如果您需要以您的母语提供帮助,请致电1-800-440-4347 (TTY: 1-800-718-4347)。另外还提供针对残疾人士的帮助和服务,例如盲文和需要较大字体阅读,也是方便取用的。请致电1-800-440-4347 (TTY: 1-800-718-4347)。这些服务都是免费的。 (Farsi) مطلب به زبان فارسی توجه: اگر میخواهید به زبان خود کمک دریافت کنید، با 1-800-440-4347 (TTY: 1-800-718-4347) تماس بگیرید. کمکها و خدمات مخصوص افراد دارای معلولیت، مانند نسخههای خط بریل و چاپ با حروف بزرگ، نیز موجود است. با 1-800-440-4347 (TTY: 1-800-718-4347) تماس بگیرید. این خدمات رایگان ارائه میشوند. ह िंदी टैगलाइन (Hindi) ध्यान दें: अगर आपको अपनी भाषा में सहायता की आवश्यकता है 1-800-440-4347 (TTY: 1-800-718-4347) पर कॉल करें। अशक्तता वाले लोगोों के ललए सहायता और सेवाएों, जैसे ब्रेल और बडे लरोंट में भी दस्तावेज़ उपलब्ध हैं। 1-800-440-4347 (TTY: 1-800-718-4347) पर कॉल करें। ये सेवाएों लन: शुल्क हैं। Nqe Lus Hmoob Cob (Hmong) CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus hu rau 1-800-440-4347 (TTY: 1-800-718-4347). Muaj cov kev pab txhawb thiab kev pab cuam rau cov neeg xiam oob qhab, xws li puav leej muaj ua cov ntawv su thiab luam tawm ua tus ntawv loj. Hu rau 1-800-440-4347 (TTY: 1-800-718-4347). Cov kev pab cuam no yog pab dawb xwb. 日本語表記 (Japanese) 注意日本語での対応が必要な場合は 1-800-440-4347 (TTY: 1-800-718-4347)へお電話ください。点字の資料や文字の拡大表示など、障がいをお持ちの方のためのサービスも用意しています。1-800-440-4347 (TTY: 1-800-718-4347) へお電話ください。これらのサービスは無料で提供しています。 한국어 태그라인 (Korean) 유의사항: 귀하의 언어로 도움을 받고 싶으시면 1-800-440-4347 (TTY: 1-800-718-4347) 번으로 문의하십시오. 점자나 큰 활자로 된 문서와 같이 장애가 있는 분들을 위한 도움과 서비스도 이용 가능합니다. 1-800-440-4347 (TTY: 1-800-718-4347) 번으로 ___________문의하십시오. 이러한 서비스는 무료로 제공됩니다. ແທກໄລພາສາລາວ (Laotian) ປະກາດ: ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫ ຼືອໃນພາສາຂອງທ່ານໃຫ້ໂທຫາເບີ 1-800-440-4347 (TTY: 1-800-718-4347). ຍັງມີຄວາມຊ່ວຍເຫ ຼືອແລະການບໍລິການສໍາລັບຄົນພິການ ເຊັ່ນເອກະສານທີ່ເປັນອັກສອນນູນແລະມີໂຕພິມໃຫຍ່ ໃຫ້ໂທຫາເບີ 1-800-440-4347 (TTY: 1-800-718-4347). ການບໍລິການເຫ ົ່ານີ້ບໍ່ຕ້ອງເສຍຄ່າໃຊ້ຈ່າຍໃດໆ. Mien Tagline (Mien) LONGC HNYOUV JANGX LONGX OC: Beiv taux meih qiemx longc mienh tengx faan benx meih nyei waac nor douc waac daaih lorx taux 1-800-440-4347 (TTY: 1-800-718-4347). Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh, beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh sou se mbenc nzoih bun longc. Douc waac daaih lorx 1-800-440-4347 (TTY: 1-800-718-4347). Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv nyaanh oc. ਪੰਜਾਬੀ ਟੈਗਲਾਈਨ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਹਾਨ ੂੰ ਆਪਣੀ ਭਾਸਾ ਧ ਿੱਚ ਮਿਿ ਿੀ ਲੋੜ ਹੈ ਤਾਂ ਕਾਲ 1-800-440-4347 (TTY: 1-800-718-4347). ਅਪਾਹਜ ਲੋਕਾਂ ਲਈ ਸਹਾਇਤਾ ਅਤੇ ਸੇ ਾ ਾਂ, ਧਜ ੇਂ ਧਕ ਬ੍ਰੇਲ ਅਤੇ ਮੋਟੀ ਛਪਾਈ ਧ ਿੱਚ ਿਸਤਾ ੇਜ਼, ੀ ਉਪਲਬ੍ਿ ਹਨ| ਕਾਲ ਕਰੋ 1-800-440-4347 (TTY: 1-800-718-4347). ਇਹ ਸੇ ਾ ਾਂ ਮੁਫਤ ਹਨ| Русский слоган (Russian) ВНИМАНИЕ! Если вам нужна помощь на вашем родном языке, звоните по номеру 1-800-440-4347 (TTY: 1-800-718-4347). Также предоставляются средства и услуги для людей с ограниченными возможностями, например документы крупным шрифтом или шрифтом Брайля. Звоните по номеру 1-800-440-4347 (TTY: 1-800-718-4347). Такие услуги предоставляются бесплатно. Mensaje en español (Spanish) ATENCIÓN: si necesita ayuda en su idioma, llame al 1-800-440-4347 (TTY: 1-800-718-4347). También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes. Llame al 1-800-440-4347 (TTY: 1-800-718-4347). Estos servicios son gratuitos. Tagalog Tagline (Tagalog) ATENSIYON: Kung kailangan mo ng tulong sa iyong wika, tumawag sa 1-800-440-4347 (TTY: 1-800-718-4347). Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan,tulad ng mga dokumento sa braille at malaking print. Tumawag sa 1-800-440-4347 (TTY: 1-800-718-4347). Libre ang mga serbisyong ito. แท็กไลน์ภาษาไทย (Thai) โปรดทราบ: หากคุณต้องการความช่วยเหลือเป็นภาษาของคุณ กรุณาโทรศัพท์ไปที่หมายเลข 1-800-440-4347 (TTY: 1-800-718-4347)นอกจากนี้ ยังพร้อมให้ความช่วยเหลือและบริการต่าง ๆ สาหรับบุคคลที่มีความพิการ เช่น เอกสารต่าง ๆ ที่เป็นอักษรเบรลล์และเอกสารที่พิมพ์ด้วยตัวอักษรขนาดใหญ่ กรุณาโทรศัพท์ไปที่หมายเลข 1-800-440-4347 (TTY: 1-800-718-4347) ไม่มีค่าใช้จ่ายสาหรับบริการเหล่านี้ Примітка українською (Ukrainian) УВАГА! Якщо вам потрібна допомога вашою рідною мовою, телефонуйте на номер 1-800-440-4347 (TTY: 1-800-718-4347). Люди з обмеженими можливостями також можуть скористатися допоміжними засобами та послугами, наприклад, отримати документи, надруковані шрифтом Брайля та великим шрифтом. Телефонуйте на номер 1-800-440-4347 (TTY: 1-800-718-4347). Ці послуги безкоштовні. Khẩu hiệu tiếng Việt (Vietnamese) CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-800-440-4347 (TTY: 1-800-718-4347). Chúng tôi cũng hỗ trợ và cung cấp các dịch vụ dành cho người khuyết tật, như tài liệu bằng chữ nổi Braille và chữ khổ lớn (chữ hoa). Vui lòng gọi số 1-800-440-4347 (TTY: 1-800-718-4347). Các dịch vụ này đều miễn phí.    

Helpful Information and Resources - Holiday Schedule

day, January 17, 2022 President's Day - Monday, February 21, 2022 Memorial Day - Monday, May 30, 2022 Juneteeth - Monday, June 20, 2022 Independence Day - Monday, July 4, 2022 Labor Day - Monday, September 5, 2022 Veteran's Day - Friday, November 11, 2022 Thanksgiving Day - Thursday, November 24, 2022 Day after Thanksgiving - Friday, November 25, 2022 Day before Christmas Eve - Friday, December 23, 2022 Day after Christmas - Monday, December 26, 2022 Day before New Year's Eve - Friday, December 30, 2022  

Governing Board Meetings - 2022 Meeting Schedule and Locations

n to the public. We invite you to join us at the next board meeting. You can also download a copy of our most current monthly board report. Dr. Bradley P. Gilbert Center for Learning and Innovation 9500 Cleveland Avenue Rancho Cucamonga, CA 91730 Click here to view the meeting room map.  Any Member of the public may observe the scheduled proceedings by using the link listed below. Click here to join the virtual meeting.   Inland Empire Health Plan Dates & Times Monday, January 10, 2022 9:00 a.m. Thursday, February 17, 2022 - Meeting canceled   Monday,  March 14, 2022 9:00 a.m. Monday, April 11, 2022 9:00 a.m. Monday, May 9, 2022 9:00 a.m.  Monday, June 13, 2022 9:00 a.m.  Monday, July 11, 2022 9:00 a.m.  Monday, August 8, 2022 9:00 a.m.  Monday, September 12, 2022 9:00 a.m.  Tuesday, October 11, 2022 9:00 a.m. Monday, November 14, 2022 9:00 a.m.  Monday, December 12, 2022 9:00 a.m. 

Pharmacy Services - DHCS Medi-Cal Rx

e January 1, 2022, the Medi-Cal pharmacy benefits and services are administered by DHCS in the Fee-For-Service (FFS) delivery system, known as "Medi-Cal Rx." Magellan Medicaid Administration, Inc. (MMA) assumes operations for Medi-Cal Rx on behalf of the State of California Department of Health Care Services (DHCS). How to Register for the User Administration Console (UAC) (PDF) User Administration Console (UAC) Quick Start Guide (PDF) Medi-Cal Rx 101 Webinar Presentation (PDF) IEHP and DHCS strongly recommends our Providers to visit the new Medi-Cal Rx website (https://medi-calrx.dhcs.ca.gov) to register for the Magellan Medi-Cal Rx portal, review schedule of trainings available on the new Medi-Cal Rx Portal, and review general information about the transition. Communication from DHCS Please refer to the DHCS Medi-Cal Rx: Transition and DHCS Medi-Cal Provider Pharmacy News Bulletins pages for additional information.   Communication from IEHP While you can always refer to Pharmacy Communication and Provider Correspondence pages, the below list is provided for your convenience. July 11, 2022 - Medi-Cal Rx Gradual Reinstatement of PAs - Phase 1 (PDF) June 03, 2022 - Medi-Cal RX Billing Policy for Physician Administered Drugs (PADs) (PDF) February 17, 2022 - RETRACTION - Medi-Cal Rx Transition - Continuous Glucose Monitors (CGM - PCP) (PDF) February 17, 2022 - RETRACTION - Medi-Cal Rx Transition - Continuous Glucose Monitors (CGM - IPA)  (PDF) February 14, 2022 - Medi-Cal Rx Transition Survey - Your Response is Important! (PDF) February 11, 2022 - Updated - Medi-Cal Rx Transition - Implantable and Injectable Contraceptives FAQs (PDF) February 09, 2022 - Medi-Cal Rx Transition - Hyaluronic Acid Knee Injections (PDF) February 07, 2022 - Medi-Cal Rx UPDATE: Revised Prior Auth Policy for Prescribers and Emergency Fill Quantity Limit (PDF) February 07, 2022 - Medi-Cal Rx Transition - How To Assist IEHP Members (PDF) January 18, 2022 - Medi-Cal Rx Transition - Implantable and Injectable Contraceptives (PDF) January 18, 2022 - Medi-Cal Rx (Magellan) Customer Service (PDF) January 18, 2022 - Medi-Cal Rx Transition - Continuous Glucose Monitors (CGM) (PDF) January 04, 2022 - CORRECTION! Medi-Cal Rx: Mail Order for Blood Pressure Monitors and Nebulizers (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

P4P - Proposition 56 - GEMT - Pay for Performance (P4P)

(IEHP) Pay for Performance program, also known as P4P. IEHP’s P4P was designed to increase the provision of preventive health services to IEHP Members as well as improve HEDIS® results to ensure that all IEHP Direct DualChoice Members receive timely annual assessment visits with an emphasis on review and management of chronic illnesses. IEHP Direct PCPs will be reimbursed directly by IEHP through the DualChoice Annual Visit program. PCPs participating in IEHP's network through an IPA only are not eligible for this program: Overview (PDF) DualChoice Annual Visit (PDF) To learn more about P4P IEHP DualChoice Annual Visit, contact a Provider Services Representative at (909) 890-2054. Click on the following links to jump to that specific section: Provider Quality Incentives Brochure Medicare P4P IEHP Direct Global Quality P4P Program OB/GYN P4P Program Hospital P4P Program Provider Quality Incentives Brochure Inland Empire Health Plan (IEHP) is pleased to announce the 2022 Provider Quality Incentive Brochure. 2022 Provider Quality Incentive Brochure (PDF) | June 22, 2022 (Back to P4P Menu) Medicare P4P IEHP Direct Program Inland Empire Health Plan (IEHP) is pleased to announce the Medicare P4P IEHP Direct Program.  The goal of the program is designed to reward IEHP Direct Primary Care Providers (PCPs) for providing quality care to IEHP DualChoice Members. Medicare P4P IEHP Direct - Kickoff Meeting (PDF) | May 20, 2021 Medicare P4P IEHP Direct Program Guide (PDF) Published: May 03, 2022 (Back to P4P Menu) Global Quality P4P Program If you would like more information about IEHP’s GQ P4P Program or best practices to help improve quality scores and outcomes, visit our Secure Provider Portal, email the Quality Team at QualityPrograms@iehp.org or call the IEHP Provider Relations Team at (909) 890-2054. 2022 IEHP Global Quality P4P Program Guide PCP (PDF) Published: September 30, 2022 2022 IEHP Global Quality P4P Program Guide IPA (PDF) Published: September 21, 2022 2021 IEHP Global Quality P4P Program Guide PCP (PDF) Published: August 30, 2022 2021 IEHP Global Quality P4P Program Guide IPA (PDF) Published: August 30, 2022 2022 Provider Quality Resource Guide (PDF) Published: July 14, 2022 (Back to P4P Menu) Quality Improvement Activity Strategy Forms The Quality Improvement Activity (QIA) Strategy Forms can be used for the following 2022 Global Quality P4P QIA Activities: Reducing Health Disparities and Potentially Avoidable Emergency Department Visits or Potentially Preventable Admissions. 2022 Equity Quality Improvement Activity #1 - Strategy Form (PDF) 2022 Quality Improvement Activity #2 - Strategy Form (PDF) (Back to P4P Menu) Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Codes The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive. Potentially Preventable Diagnosis List (PDF) Published: February 04, 2022 Patient Experience This toolkit is full of proven tips and successful strategies based on the kinds of questions your IEHP Members could be asked to answer regarding their Provider's service. Your Provider Relations Team has targeted nine specific topics in this toolkit to help Providers and their staff continue to achieve the highest marks in Patient experience from their IEHP Members. Serve Well Customer Service Toolkit (PDF) Well Child 2021 Recommendations for Preventive Pediatric Health Care from the American Academy of Pediatrics (PDF) Immunizations IEHP provides vaccine coverage based on the latest ACIP recommendation and guidelines. Please refer to the Immunization Update and "Summary of Recommendations" for both Child and Adolescents AND Adult Vaccines as follows: 2022 Immunization Timing Chart - English (PDF) 2022 Immunization Timing Chart - Spanish (PDF) 2022 Immunization Timing Chart - Chinese (PDF) 2022 Immunization Timing Chart - Vietnamese (PDF) Immunization Updates (PDF) 2021 Recommended Child and Adolescent Immunization Schedule (0-18 years) (PDF) 2021 Recommended Adult Immunization Schedule (19+ years) (PDF) Adult Vaccines are a covered benefit and do not require prior authorization (must adhere to CDC/ACIP Immunization Recommendation and/or FDA approved indication). Grow Well Childhood Immunization Toolkit for Providers (PDF) This toolkit contains commonly used immunization codes, best practices for reporting immunizations including information on registering with CAIR, tips on talking with parents and information on understanding vaccination hesitancy. CAIR2 Resource Guide (PDF) This guide contains helpful links and contact information for locations to register for CAIR2 or current users. Reimbursement process: Complete a CMS1500 form by including the appropriate CPT codes, quantity dispensed and billed amount. Mail:  IEHP Claims Department P.O. Box 4349  Rancho Cucamonga, CA 91729-4349. For the latest updates and news regarding the vaccines, please visit CDC's ACIP website at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. By clicking on this link, you will be leaving the IEHP website. (Back to P4P Menu) OB/GYN P4P Program Inland Empire Health Plan (IEHP) has released the OB/GYN P4P Program Guide which details the program requirements, performance measures, updated code sets, and payment timelines. OB/GYN P4P Program Guide (PDF) Published: September 07, 2022 OB P4P Frequently Asked Questions FAQs (PDF) Published: March 09, 2022 Postpartum Depression Screening (PDF) (Back to P4P Menu) Hospital P4P Program Inland Empire Health Plan (IEHP) is pleased to announce the Hospital Pay For Performance Program (Hospital P4P) for IEHP Medi-Cal contracted Hospitals servicing Riverside and San Bernardino Counties. The goal of the Hospital P4P Program is to provide substantial financial rewards to Hospitals that meet quality performance targets and demonstrate high-quality care to IEHP Members. 2022 Hospital P4P Program Guide (PDF) Published: August 30, 2022 P4P 2022 MX Data Contribution (PDF) Published: April 18, 2022 P4P 2022 MX Data Guidelines (PDF) Published: April 18, 2022 2021 Hospital P4P Program Guide (PDF) Update #3, Published: April 01, 2021 P4P 2021 Data Guidelines (PDF) Update #2, Published: April 16, 2021 P4P 2021 MX Data Contribution (PDF) Published: January 12, 2021 (Back to P4P Menu) Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Codes The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive. Potentially Preventable Diagnosis List (PDF) Published: February 04, 2022 (Back to P4P Menu) Substance Use Disorders and Mental Health Diagnosis Lists The Substance Use Disorders and Mental Health Diagnosis Lists includes diagnosis codes to identify substance use disorders, drug overdose, mental health or intentional self-harm diagnoses. Mental Health Diagnosis List (PDF) Published: February 02, 2022 Substance Use Disorders Diagnosis List (PDF) Published: February 02, 2022 (Back to P4P Menu)   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here

Plan Updates - Public Health Advisory

Riverside University Health System - Monkeypox Home Isolation Instructions (PDF) August 18, 2022 - CDC - Dear Colleague: 2022 Monkeypox Outbreak (PDF) July 19, 2022 - Updated Monkeypox Guidance (PDF) March 14, 2022 - Riverside County Legionnaires' Disease Advisory (PDF) February 24, 2022 - PHA Gonococcal Infections (PDF) February 1, 2022 - CHDP Upcoming Trainings (PDF) January 31, 2022 - San Bernardino County Black Infant Health Program - Two Locations (PDF) December 01, 2021 - San Bernardino County - Safe Sleep Video (Provided by Children's Network) November 05, 2021 - CDC - Expansion of Recall of LeadCare Blood Lead Tests Due to Risk of Falsely Low Results (PDF) March 05, 2021 - Health Alert: Ebola Virus Disease Outbreak (PDF) By clicking on the links below, you will be leaving the IEHP website. Riverside County Public Health San Bernardino County Public Health Visit Riverside County Public Health System to view all of RCPH advisories. Visit San Bernardino County's Public Health to view all SBCPH news releases. Centers for Disease Control and Prevention (CDC) The CDC has developed a one-stop-shop toolkit with products about vaccines and measles. These products include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. (By clicking the links below, you will be leaving the IEHP website.) Measles Outbreak Toolkit Toolkit for Healthcare Providers Measles FAQs California Department of Public Health (CDPH) The California Department of Public Health (CDPH) has developed two new measles tools for providers. Both tools are attached and can be found on the CDPH Measles Disease webpage. (By clicking on this link, you will be leaving the IEHP website.) Summary of Current Recommendations on Measles Immunization CDPH (PDF) Should I Test for Measles: A Guide for California Healthcare Providers (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. (By clicking on this link, you will be leaving the IEHP website.)

Provider Communications - Provider Communications

later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website   September 2022 Notice(s): 09/08/2022 Recalls, Withdrawals & Safety Alerts  (PDF) 09/02/2022: August 2022 P&T Update (PDF) August 2022 Notice(s): 08/29/2022 Medication Reconciliation Program (PDF) 08/22/2022 Medication Reconciliation Program (PDF) 08/15/2022 Medication Reconciliation Program (PDF) 08/10/2022 Recalls, Withdrawals & Safety Alerts  (PDF) 08/01/2022 Medication Reconciliation Program  (PDF)   July 2022 Notice(s): 07/07/2022 Recalls, Withdrawals & Safety Alerts  (PDF) June 2022 Notice(s): 06/22/2022: May 2022 P&T Update (PDF) 06/08/2022 MTM Medi-Cal Provider Mailing Campaign (PDF) 06/08/2022 MTM Medicare Provider Mailing Campaign (PDF) 06/05/2022 Recalls, Withdrawals & Safety Alerts  (PDF) 06/04/2022 Academic Detailing Services Now Offered (PDF)   May 2022 Notice(s): 05/05/2022 Recalls, Withdrawals & Safety Alerts  (PDF) April 2022 Notice(s): 04/05/2022 Important Notice: Proton Pump Inhibitor Overutilization (PDF) 04/05/2022 Recalls, Withdrawals & Safety Alerts  (PDF) March 2022 Notice(s): 03/29/2022 MTM Medi-Cal Provider Mailing Campaign (PDF) 03/29/2022 MTM Medicare Provider Mailing Campaign (PDF) 03/16/2022 New DHCS DUR Board Educational Article (PDF) 03/07/2022 Recalls, Withdrawals & Safety Alerts (PDF) February 2022 Notice(s): 02/14/2022 Important notice: Insulin misutilization (PDF) 02/07/2022 Recalls, Withdrawals & Safety Alerts (PDF) January 2022 Notice(s): 01/05/2022 Recalls, Withdrawals & Safety Alerts  (PDF) December 2021 Notice(s): 12/21/2021 IEHP Formulary Changes: Nov P&T Update (PDF) 12/10/2021 Notice of High-Risk Medications Drug Alternative(s) Reference Guide- New 2019 Update to the AGS Beers Criteria (PDF) 12/10/2021 Medi-Cal Rx Transition: Blood Pressure Monitors and Nebulizers (PDF) 12/08/2021 Recalls, Withdrawals & Safety Alerts (PDF) November 2021 Notice(s): 11/03/2021 Recalls, Withdrawals & Safety Alerts  (PDF) October 2021 Notice(s): 10/28/2021 Recalls, Withdrawals & Safety Alerts (PDF) 10/13/2021 New DHCS DUR Board Educational Article (PDF) September 2021 Notice(s): 09/17/2021 IEHP Formulary Changes: August P&T Update (PDF) 09/16/2021 FDA Requests Removal of Pregnancy Contraindication of Statins (PDF) 09/16/2021 Voluntary Recall of Varenicline (Chantix) Lots Containing Nitrosamine (PDF) 09/01/2021 Recalls, Withdrawals & Safety Alerts (PDF) August 2021 Notice(s): 08/04/2021 Recalls, Withdrawals & Safety Alerts (PDF) July 2021 Notice(s): 07/06/2021 Recalls, Withdrawals & Safety Alerts (PDF) June 2021 Notice(s): 06/18/2021 Recalls, Withdrawals & Safety Alerts (PDF) May 2021 Notice(s): 06/18/2021 IEHP Formulary Changes: May 2021 P&T Update(PDF) May 2021 Notice(s): 05/05/2021 Recalls, Withdrawals & Safety Alerts (PDF) April 2021 Notice(s): 04/08/2021 Recalls, Withdrawals & Safety Alerts (PDF) March 2021 Notice(s): 03/02/2021 Recalls, Withdrawals & Safety Alerts (PDF) February 2021 Notice(s): 02/12/2021 Reminder: Diabetic Blood Glucose Testing Supplies (PDF) 02/11/2021 Recalls, Withdrawals & Safety Alerts (PDF) January 2021 Notice(s): 01/29/2021 Reminder: Specialty Cuffs for Blood Pressure Monitors (PDF) 01/28/2021 Medication Therapy Management Services (PDF)  01/06/2021 Recalls, Withdrawals & Safety Alerts (PDF)  December 2020 Notice(s): 12/28/2020 IEHP Formulary Changes: November 2020 P&T Update (PDF) 12/21/2020 Notice of Termination of Hepatitis Center of Excellence Program (PDF) 12/18/2020 IEHP Formulary Changes: November 2020 P&T Update (PDF) 12/09/2020 Recalls, Withdrawals & Safety Alerts (PDF)  November 2020 Notice(s): 11/04/2020 Recalls, Withdrawals & Safety Alerts (PDF)  October 2020 Notice(s): 10/15/2020 Recalls, Withdrawals & Safety Alerts (PDF)  10/13/2020 Completion of a Request for Medication Coverage  (PDF) September 2020 Notice(s): 09/18/2020 Specialty Cuffs for Blood Pressure Monitors (PDF) 09/09/2020 Recalls, Withdrawals & Safety Alerts (PDF) August 2020 Notice(s): 08/19/2019 2020-2021 Flu Vaccination for IEHP Members (PDF) 08/05/2020 Recalls, Withdrawals & Safety Alerts (PDF) July 2020 Notice(s): 07/08/2020 Recalls, Withdrawals & Safety Alerts (PDF) June 2020 Notice(s): 06/24/2020 Important Notice: New FDA Guidelines for Hydroxychloroquine and Chloroquine (PDF) 06/17/2020 Recalls, Withdrawals & Safety Alerts (PDF) 06/10/2020 Medication Reconciliation Post Discharge (MRP) (PDF) May 2020 Notice(s): 05/27/2020 Important Notice: Member Open Access for Nebulizers (PDF) 05/04/2020 Recalls, Withdrawals & Safety Alerts (PDF) April 2020 Notice(s): 04/16/2020 Important Notice: Blood Pressure Monitors Added to Formulary (PDF) 04/07/2020 Patient Access to Prescription Drugs (PDF) 04/06/2020 Recalls, Withdrawals & Safety Alerts (PDF) 04/01/2020 P&T February 2020 Formulary Changes Notice (PDF) March 2020 Notice(s): 03/31/2020 Important Notice: Medi-Cal Formulary Update for Test Strips and Lancets (PDF) 03/25/2020 Hydroxychloroquine Formulary Change (PDF) 03/05/2020 Recalls, Withdrawals & Safety Alerts (PDF) February 2020 Notice(s): (PDF)02/03/2020 Recalls, Withdrawals & Safety Alerts   (PDF) 02/01/2020 Medi-Cal Formulary Change December 2019 Notice(s): 12/31/2019 Recalls, Withdrawals & Safety Alerts (PDF) 12/03/2019 Recalls, Withdrawals & Safety Alerts (PDF) November 2019 Notice(s): 11/07/2019 Recalls, Withdrawals & Safety Alerts (PDF) 11/08/2019 Closed Walgreens Pharmacies (PDF) October 2019 Notice(s): 10/01/2019 P&T August 2019 Formulary Changes Notice (PDF) 10/03/2019 Recalls, Withdrawals & Safety Alerts (PDF) September 2019 Notice(s): 09/05/2019 Recalls, Withdrawals & Safety Alerts (PDF) August 2019 Notice(s): 08/30/2019 2019-2020 Flu Vaccination for IEHP Members (PDF) 08/02/2019 Recalls, Withdrawals & Safety Alerts (PDF) July 2019 Notice(s): 07/01/2019 P&T May 2019 Formulary Changes Notice (PDF) 07/03/2019 Recalls, Withdrawals & Safety Alerts (PDF) June 2019 Notice(s): 06/04/2019 Recalls, Withdrawals & Safety Alerts (PDF) 6/05/2019 Reminder: IEHP Medi-Cal Formulary Change for Invokana, Invokamet, and Invokamet XR (PDF) 6/26/2019 Reminder: IEHP Medi-Cal Formulary Change for Invokana, Invokamet, and Invokamet XR (PDF) May 2019 Notice(s): 05/09/2019 Recalls, Withdrawals & Safety Alerts (PDF) April 2019 Notice(s): 04/30/2019 Reminder: IEHP Medi-Cal Formulary Change for Invokana, Invokamet, and Invokamet XR (PDF) 04/01/2019 P&T February 2019 Formulary Changes Notice (PDF) 04/12/2019 IEHP Medi-Cal Formulary Change for Invokana, Invokamet and Invokamet XR (PDF) 04/12/2019 Medi-Cal Opioid Restrictions (PDF) March 2019 Notice(s): 03/05/2019 California Winter Storm (PDF) February 2019 Notice(s): 02/01/2019 Medi-Cal Change for Lantus(PDF) January 2019 Notice(s): 01/01/2019 Medi-Cal Change for Lantus (PDF) 01/01/2019 P&T Formulary Change Notice (PDF) December 2018 Notice(s): 12/05/2018 Opioid and Benzodiazepine Restrictions for Medicare Members (PDF) 12/03/2018 Medi-Cal Formulary Change for Lantus (PDF) November 2018 Notice(s): 11/16/2018 Reminder: IEHP Medi-Cal Formulary Change for Januvia, Janumet, and Janumet XR (PDF) 11/01/2018 Medi-Cal Formulary Change for Januvia, Janumet and Janumet XR (PDF) October 2018 Notice(s): 10/12/2018 Medi-Cal Formulary Change for Januvia, Janumet and Janumet XR (PDF) 10/01/2018 P&T Formulary Changes Notice (PDF) September 2018 Notice(s): 09/20/2018 Medi-Cal Formulary Change for Januvia, Janumet and Janumet XR (PDF) July 2018 Notice(s): 07/10/2018 Provider Screening and Enrollment (PDF) 07/01/2018 P&T Formulary Changes Notice (PDF) 07/01/2018 Recalls, Market Withdrawals & Safety Alerts (PDF) June 2018 Notice(s): 06/01/2018 Recalls, Withdrawals & Safety Alerts (PDF) May 2018 Notice(s): 05/02/2018 Recalls, Withdrawals & Safety Alerts (PDF) April 2018 Notice(s): 04/02/2018 Recalls, Market Withdrawals & Safety Alerts (PDF) March 2018 Notice(s): 03/30/2018 Changes to Contraceptive Devices (PDF) 03/05/2018 Recalls, Market Withdrawals & Safety Alerts (PDF) February 2018 Notice(s): 02/08/2018 Use of Diclegis in Pregnancy-Induced Nausea and Vomiting (PDF) 02/02/2018 Recalls, Market Withdrawals & Safety Alerts (PDF) January 2018 Notice(s): 01/31/2018 Use of Lidocaine 5% Patch in Postherpetic Neuralgia (PDF) 01/03/2018 Recalls, Market Withdrawals & Safety Alerts (PDF) 01/03/2018 P&T Formulary Changes Notice (PDF) 01/02/2018 Pharmacy P4P: Provider Impact (PDF)

Member Advisory Committee - Public Policy Participation Committee

ces and feedback guide our services. As a result, we are able to improve how we deliver care and services. The PPPC meets every three months. We bring together IEHP staff and Members to give our Members a platform for open discussion. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss the IEHP Cultural and Linguistic (C&L) services program. Members who are selected to participate, will get $75 for each meeting they attend. 2022 Meeting Schedule March 16, 2022 (virtual) June 15, 2022 September 21, 2022 December 21, 2022  

Member Advisory Committee - Persons with Disabilities Workgroup

uide our services. As a result, we are able to improve how we deliver care and services. If you are an IEHP Member with a disability, you can request to be a Member of our PDW.  The PDW meets every three months at IEHP. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss any communication needs and access issues that Members may have. To apply for membership in this workgroup, please call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. 2022 Meeting Schedule March 31, 2022 June 23, 2022 September 22, 2022 December 15, 2022 Time: 12pm - 2pm

Plan Updates - Correspondence

here. TITLE DATE RECIPIENTS September 2022     Global Quality P4P Programs – NEW 2022 Quality Bonus Services! 09/30 All Medi-Cal PCPs Diversity Awareness Month - October 2022 - Please Join Us! 09/30 All IEHP Providers & IPAs REMINDER - IEHP Coordination of Benefits Agreement (COBA) Implementation – Action Required! 09/30 All PCPs, Specialists, ANC & Hospitals ICD-10-CM Risk Adjustment Code Changes for CMS HCC Code Capture 09/26 All Direct Dual Choice PCPs UPDATE! – Continuous Glucose Monitoring (CGM) Systems (IPA) 09/23 All Medi-Cal IPAs UPDATE! – Continuous Glucose Monitoring (CGM) Systems 09/22 All Medi-Cal PCPs & Endocrinologists ACTION REQUIRED - Electronic Visit Verification (EVV) Implementation Requirements – Self Registration Required by October 19, 2022 09/22 All Home Health Care Services (HHCS) Providers & Personal Care Services (PCS) UPDATED Medi-Cal Letter Templates 09/22 All Medi-Cal IPAs URGENT ATTENTION: Phishing Email Alert 09/21 All IEHP Providers Pharmacy Times - Medication Reconciliation 09/21 All Dual Choice PCPs Grievance Process Updates - Grievance Summary Form - Due Date 09/15 All IPAs Continuity of Care (COC) Rosters Now Available on SFTP 09/15 All IPAs REMINDER - Enhanced Care Management Available for Members 09/15 All Medi-Cal ANC and Vision Providers  Coordination of Benefits Agreement (COBA) Implementation - Action Required 09/12 All PCPs, Specialists, ANC & Hospitals REMINDER - Dilated Retinal Exam (DRE) for Diabetic Members 09/09 All PCPs & Vision Providers Revised UM Authorization Guidelines 09/09 All IPA Administrators & Medical Directors Annual BH&CM Medi-Cal IPA Training Survey 09/08 All Medi-Cal IPA Care Management Staff IEHP Provider Portal Updates – Reports now Viewable by TIN 09/08 All Medi-Cal PCPs NEW - Collecting Social Determinants of Health Data (SDOH) 09/08 All Medi-Cal PCPs, Specialists & BH Providers Authorization Timeframes Notice of Action (NOA) Translation & Attachment 09/08 All Medi-Cal IPAs Please Notify IEHP if Your Availability has Changed due to Area Fires 09/08 All Hemet and Big Bear Area Providers  IEHP Formulary Changes (P&T) 09/07 All IEHP PCPs Access Standards - Appointment Availability - Specialists 09/02 All Specialists Access Standards - Appointment Availability - PCP, Ob 09/02 All PCPs & Obs Access Standards - Appointment Availability - BH 09/02 All Behavioral Health Providers Vaccination Clinic and Resource Fair - September 10 09/02 All Direct PCPs IEHP Medi-Cal Medical Benefit Formulary 09/02 All Medi-Cal PCPs, Specialists & Psychiatrists August 2022     2022 - 2023 Flu Vaccination for IEHP Members  08/31 All Pharmacy Providers REMINDER: Medi-Cal Rx Gradual Reinstatement of PAs – Phase 1 08/31 All Medi-Cal PCPs & Specialists Labor Day Holiday 08/30 All IEHP Providers & IPAs REMINDER: Enhanced Care Management Available for Members 08/30 All Medi-Cal PCPs & IPAs Final REMINDER: Submit the 2022 Provider Satisfaction Survey 08/29 All PCPs, Specialists & BH Providers REMINDER: Community Supports Services Available for Members 08/29 All PCPs, Specialists & BH Providers NOTICE: DHCS Approved Letter – Prior Authorization Not Required 08/26 All Medi-Cal IPAs NOTICE: DHCS Approved Letter – Prior Authorization Not Required 08/26 All Medi-Cal PCPs, Specialists & Ambulatory Surgery Centers REMINDER: Aug 2022 Provider Educational Series: “How to Navigate Rosters & Reports” 08/24 All Direct Medi-Cal PCPs NEW: Health Education Classes Offered in Desert Hot Springs and Mecca 08/24 All Coachella Valley PCPs ADVISORY: Updated Monkeypox Guidance 08/23 All Riverside County PCPs San Bernardino County Public Health - Monkeypox Guidance 08/23 All San Bernardino County PCPs & Specialists REMINDER: Medication Reconciliation 08/22 All IEHP Providers REMINDER: 2022 Provider Satisfaction Survey 08/22 All PCPs, Specialists, & BH Providers REMINDER: DHCS Quarterly Timely Access Survey 08/22 All Medi-Cal PCPs, Specialists, BH & Ancillary Providers Reinstatement of PA Requirements for 11 Drug Classes 08/17 All Medi-Cal PCPs REMINDER: Appropriate Billing for Dispensing of Vision Materials 08/17 All Vision Providers REMINDER: Provider Directory Verification Form due August 26th 08/17 Select PCPs & Specialists REMINDER: Timely Provision of Denial Packets 08/12 All Medicare IPAs Member Grievance Updates: Medical Record Requests 08/12 All Direct PCPs, Specialists, & Ancillary 2022 Global Quality P4P Program Guide Updates - SDOH Rate Measure 08/12 All Medi-Cal PCPs & IPAs Medi-Cal Letter Templates 08/11 All Medi-Cal IPAs UPDATE: IEHP’s Network is Open to New QASP Providers 08/08 All BHT Providers 2022 Provider Educational Series – How to Navigate Rosters & Reports 08/08 All Direct Medi-Cal PCPs Proposition 56 – Don’t Miss Out on Available Supplemental Payments 08/05 All Medi-Cal PCPs 2022 Provider Quality Resource Guide 08/05 All PCPs Changes to Quarterly Workplan Requirements 08/03 All IPAs REMINDER: Provider Preventable Conditions - Reporting Requirements 08/03 All IEHP Providers, Ambulatory Surgical Centers & IPAs Webinar: COVID-19 In the Black and Brown Community and the Post Long-Term Effects 08/01 All PCPs & IPAs July 2022     NEW DATE: Medi-Cal Rx Gradual Reinstatement of Prior Auths (PAs) – Phase 1 – September 16, 2022 07/29 All Med-Cal PCPs & Specialists Practitioner Reporting Requirements - UB-04 Claim Form 07/29 All SNFs, Hospitals, & Ancillary Free Webinar: It Takes a Village to Manage COVID-19 07/27 All PCPs & IPAs REMINDER: Medi-Cal Rx Gradual Reinstatement of PAs – Phase 1 – August 1, 2022 07/25 All Medi-Cal PCPs & Specialists ALERT: Hospice Policy and Procedures 07/25 Select Contract and Non-Contracted Hospice Providers Inappropriate Treatment Delays and Denials for HIV PrEP and PEP 07/22 All Medi-Cal PCPs & Specialists UPDATED: Telehealth Services FAQs 07/21 All PCPs, Specialists, BH, BHT Providers & IPAs 2022 Global Quality P4P Program – Provider Directory Verification 07/20 All Medi-Cal PCPs NEW: Riverside County Public Health: Updated Monkeypox Guidance 07/20 All Riverside County PCPs & Specialists DHCS Plan Data Feed Project – Files Available on SFTP 07/19 All IPAs 2022 Global Quality P4P PCP Program Guide- UPDATES 07/18 All Medi-Cal PCPs 2022 Global Quality P4P IPA Program Guide- UPDATES 07/18 All Medi-Cal IPAs 2022 Appointment Availability Survey – Fax Survey 07/15 All PCPs & IPAs 2022 Appointment Availability Survey – Fax Survey 07/15 All BH Providers 2022 Appointment Availability Survey – Fax Survey 07/14 All Specialists, Ancillary & IPAs UPDATE: Diabetic Vision Outreach Campaign – EXTENDED to July 22, 2022 07/14 All Vision Providers Medi-Cal Rx Gradual Reinstatement of PAs – Phase 1 07/11 All Medi-Cal PCPs & Specialists 2022 Global Quality P4P (GQ P4P) Interim Reports Data Refresh 07/11 All Medi-Cal PCPs & IPAs Update: Risk Adjustment Telehealth and Telephone Services 07/11 All Dual Choice PCPs, Specialists & BH Providers Cal MediConnect Sunsets and IEHP Dual Choice (D-SNP) Begins 07/08 All Medicare PCPs, Specialists & BH Providers 2022 Provider Satisfaction Survey 07/07 All PCPs, Specialists & BH Providers 2022 Provider Educational Series - Provider Directory Verification Process (Virtual) 07/07 All Medi-Cal PCPs IEHP Medi-Cal Medical Benefit Formulary 07/01 All Medi-Cal PCPs, Specialists & Psychiatrists IEHP Providers Can Post Jobs and Find Candidates for Free on SoCalDocJobs.com 07/01 All PCPs June 2022     ALERT: No Prior Authorization for Biomarker Testing for Stage 3 and 4 Metastatic Cancers 06/29 All PCPs, Specialists & IPAs REMINDER – KidVaxGrant Application Deadline Approaching 06/29 All Medi-Cal PCPs REMINDER - 2022 Provider Educational Series: Provider Directory Verification Process 06/28 All Direct Medi-Cal PCPs DHCS Plan Data Feed Project 06/27 All IPAs  Alzheimer’s and Dementia Care: A FREE CME Project Echo Opportunity 06/27 All IEHP Family Practice & Internal Medicine Providers Independence Day Holiday 06/27 All IEHP Providers & IPAs Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Service 06/27 All Medi-Cal IPAs UPDATED - Telehealth Services POS Code Updates 06/26 All PCPs, Specialists & BH Providers Clinical Practice Guidelines 06/24 All PCPs & IPAs Access Standards – Appointment Availability for Specialists 06/24 All Specialists NOTICE: No Prior Authorizations for Preventive Services - IPAs 06/23 All Medi-Cal IPAs NOTICE: No Prior Authorizations for Preventive Services - Providers 06/23 Direct Medi-Cal PCPs & Specialists Billing of IEHP Members Guidance 06/22 All IEHP Providers & IPAs REMINDER - 2022 Provider Educational Series: Provider Directory Verification Process 06/21 All Direct Medi-Cal PCPs Access Standards – Appointment Availability for PCPs and OB Providers 06/21 All PCPs & OB Providers Access Standards – Appointment Availability for BH Providers 06/21 All Behavioral Health Providers REMINDER – Authorizations Required for All Follow-up Visits! 06/17 All BH & BHT Providers REMINDER: 2022 Global Quality P4P Program – CAIR2 Participation Requirement 06/17 All Medi-Cal PCPs Member Campaign on Preventive Care Services 06/17 All Medi-Cal PCPs & IPAs Updates/Amendments to AB 1184: Confidential Communication of Medical Information Involving Sensitive Services 06/16 All Medi-Cal Providers & IPAs IEHP Alternative Format Requirement Overview 06/14 All IEHP Providers & IPAs Juneteenth Holiday 06/13 All IEHP Providers & IPAs REMINDER - Authorizations Required for Vision Services 06/10 All Vision Providers Alcohol and Drug Screening Assessment Brief Interventions and Referral to Treatment (SABIRT) 06/10 All PCPs & IPAs 2022 Provider Educational Series - Provider Directory Verification Process 06/10 All Direct Medi-Cal PCPs Navigating the Formula Crisis Webinar 06/08 All Medi-Cal PCPs & OB/GYN Medi-Cal Rx Billing Policy for Physician Administered Drugs (PADs) 06/03 All Medi-Cal PCPs, Specialists & IPAs New and Revised UM Authorization Guidelines 06/03 All IPA & BHT Providers UPDATES COMING SOON – Changes to UM Semi-Annual and Annual Reporting Requirements 06/01 All IPAs UPDATE - Facility Site Review (FSR) and Medical Record Review (MRR) Tools and Standards – Effective July 1, 2022 06/01 All PCPs & IPAs May 2022     IEHP’s Bi-Annual BHT Provider Training 05/27 All Behavioral Health Treatment (BHT) Providers Memorial Day Holiday 05/23 All Providers & IPAs REMINDER: CMC Transition to D-SNP - Model of Care Early Preview Meeting - June 13, 2002 05/23 All IPA CM & Quality Staff 2022 Global Quality P4P Program - NEW 2022 Interim Reports 05/20 All Medi-Cal PCPs IEHP UM Department Availability 05/20 All PCPs, Specialists & BH Care Coordination REMINDER – Review the Early Start Roster on IEHP’s Portal 05/17 All Medi-Cal PCPs & IPAs CMC Transition to D-SNP - Model of Care Early Preview Meeting - June 13, 2002 05/16 All IPA CM & Quality Departments REMINDER: 2022 Global Quality P4P Program – CAIR2 Participation Requirement 05/16 All Medi-Cal PCPs REMINDER: 2022 Global Quality P4P Program – Manifest MedEx Connectivity 05/16 All Medi-Cal PCPs  eReferral Submission to IEHP now available for IPA assigned Medi-Cal Members: Transplants (MOT) and Community Support Services 05/13 All Medi-Cal PCPs & IPAs Applied Changes for Medicare Members on the 835 Files 05/10 IEHP Trading Partners Sunsetting of Proposition 56: Value Based Payment Program 05/09 All Medi-Cal PCPs, Specialists, BH & IPAs HIV/AIDS Specialist Survey 05/06 All Specialists UPDATED FAQs: Members with Other Health Coverage (OHC) 05/06 All Providers & IPAs Revised/Retired UM Authorization Guidelines 05/06 All Medi-Cal IPAs & BH Community Supports Services Modifier Guidance 05/06 All Medi-Cal PCPs, Specialists, BH & IPAs  REMINDER: No Prior Authorizations Needed for Preventive Services 05/03 All IPAs Alzheimer’s and Dementia Care: A Project Echo Opportunity 05/03 All PCPs Webinar - IWIN COVID and the Community 05/02 San Bernardino County PCPs April 2022     2022 Global Quality P4P Program - Manifest MedEx Connectivity Reminder 04/29 All Medi-Cal PCPs REMINDER - Physician Certification Statement (PCS) Requirement 04/29 All Medi-Cal PCPs, Specialists, BH & IPAs Maternal Wellness Events - May 2022 - IEHP Community Resource Centers 04/28 All Medi-Cal PCPs, OB/GYN, Peds, BH & IPAs Letter to Primary Care Providers RE-Response to GSF 04/27 All Medi-Cal PCPs Letter to Providers RE-Response to GSF 04/26 All Medi-Cal IPAs & Specialists Initial Health Assessment (IHA) Roster 04/22 All Medi-Cal PCPs & IPAs REMINDER: IEHP Interpreter Services – Benefit for Members! 04/20 All PCPs & IPAs REMINDER - 2022 Global Quality P4P Program – CAIR2 Participation Requirement 04/15 All Medi-Cal PCPs COVID-19 “Test to Treat” Initiative 04/13 All PCPs & IPAs Revised UM Authorization Guideline 04/12 All Medi-Cal IPA Administrators and Medical Directors & BH Providers Public Health Service (PHS) 340B Participating Provider Billing Reminder 04/12 All FQHCs and DSHs Care Plans and Health Risk Assessments (HRAs) Reminder 04/08 All PCPs, Specialists, SNFs & CBAS 2nd Round of Free At-Home COVID-19 Test Kits Available 04/08 All Medi-Cal PCPs Misdirected Claims Testing – Meeting Request 04/07 IEHP Trading Partners Alzheimer’s and Dementia Care: A Project Echo Opportunity 04/06 All IEHP PCPs Standing Orders Enrollment - Respond Today! 04/06 All Medicare PCPs Medicare P4P IEHP Direct – Blood Pressure Control Billing Guidance 04/05 All Direct DualChoice PCPs March 2022     CORRECTION - Standing Orders Enrollment- Respond Today! 03/31 All Medi-Cal PCPs Complex Case Management (CCM) Program – Severe Chronic Conditions 03/30 All Medi-Cal PCPs, Specialists, BH Providers & IPAs Major Organ Transplants (MOT) and TAR Approval DATE Impact 03/29 All Medi-Cal IPAs & COEs Standing Orders Enrollment - Respond Today! 03/29 All Medi-Cal PCPs Initial Health Assessment (IHA) 03/28 All Medi-Cal PCPs REMINDER - 2022 OB P4P Kickoff Meeting – March 31, 2022! 03/28 All Medi-Cal OB/GYNs CMS Signature Requirement Guidelines for Member Medical Records 03/25 All IPAs, PCPs, Specialists & BH Providers REMINDER: IEHP Claims, Appeals/Disputes and Audit Recovery Mailing Addresses 03/25 All Direct PCPs, Specialists & BH Providers 2021 GQ P4P Program- Data Submission Extension Until March 31, 2022 03/22 All Medi-Cal PCPs REMINDER: IEHP Wants to Know Your Interest in Pilot Program to Implement a Community Electronic Health Record (EHR) 03/22 All Medi-Cal PCPs REMINDER - American Rescue Plan Act – Extension of Postpartum Care Coverage 03/21 All Medi-Cal PCPs, OBs & IPAs Behavioral Health Access Standards – Appointment Availability 03/16 All Behavioral Health Providers IEHP Wants to Know: Interest in Pilot Program to Implement a Community Electronic Health Record (EHR)? 03/15 All Medi-Cal PCPs REMINDER - 2022 Global Quality P4P Program – CAIR2 Participation Requirement 03/14 All Medi-Cal PCPs & IPAs Riverside County Legionnaires' Disease Advisory 03/14 All PCPs & IPAs Coordination of Benefits with Other Health Coverage (OHC) – Medi-Medi Coverage Added to Provider Portal 03/11 All IEHP Providers & IPAs Notice of Dismissal of Coverage Letter Updates & Attestation Form 03/11 All Medicare IPAs Process for IEHP Medi-Cal Members: Continuous Glucose Monitors (CGM) 03/10 All Medi-Cal PCPs UPDATED Integrated Denial Notice Medicare Letter Templates 03/08 All Medicare IPAs Process for IEHP Medi-Cal Members: Blood Pressure Monitors and Nebulizers 03/07 All Medi-Cal PCPs IEHP’s Quarterly BH Provider Training 03/04 All Behavioral Health Providers Update: Enhanced Care Management Roster Available on Provider Portal 03/01 All Medi-Cal PCPs & IPAs February 2022     New Facility Site Review and Medical Record Review Tools and Standards effective March 1, 2022 – DHCS APL 20-006 02/28 All PCPs & IPAs 2022 OB P4P Kickoff Meeting – March 31, 2022 02/28 Medi-Cal OB/GYNs Community Supports Services Referral Process Now Available Online 02/25 BH & BHT Providers American Rescue Act Plan – Extension of Postpartum Care Coverage 02/25 Medi-Cal PCPs, OBs & IPAs PHA Gonococcal Infections 02/24 All Riverside County PCPs Vision Authorization Process – Please Do Not Submit Duplicate Requests 02/23 All Vision Providers COVID-19 Oral Antiviral Drugs – Coverage and Dispensing Pharmacies 02/23 All Medicare PCPs, Specialists & IPAs 2022 Global Quality P4P Program – PCP CAIR2 Participation Requirement 02/22 All Medi-Cal IPAs UPDATED LAUNCH DATE: Pyx Health Mobile Application: Pilot Program 02/22 All PCPs & IPAs Global Quality P4P Programs - 2022 ROSTER UPDATE -IPA 02/22 All Medi-Cal IPAs Global Quality P4P Programs – 2022 ROSTER UPDATE - PCP 02/22 All Medi-Cal PCPs RETRACTION - Medi-Cal Rx Transition: Continuous Glucose Monitors (CGM) 02/17 All Medi-Cal PCPs RETRACTION - Medi-Cal Rx Transition: Continuous Glucose Monitors (CGM) 02/17 All Medi-Cal IPAs Health Access License Surrender Update: Revised Effective Date 02/17 IEHP Direct Providers & IPAs UPDATE: Post-Service/Retrospective Auth Decision Notification Requirements 02/17 Medi-Cal IPA Administrators, UM Medical Directors & UM Staff Revised/Retired/Reviewed With No Changes UM Authorization Guidelines 02/16 IPA Administrators & Medical Directors Medi-Cal Rx Transition - Continuous Glucose Monitors (CGM) UPDATE 02/14 All Medi-Cal PCPs Medi-Cal Rx Transition Survey – Your Response is Important! 02/14 All Medi-Cal PCPs and Specialists Presidents’ Day Holiday 02/14 All IEHP Providers LTSS Roster: IHSS County Social Worker and Caregiver Info 02/14 All Medicare IPAs Updated - Medi-Cal Rx Transition: Implantable and Injectable Contraceptives FAQs 02/11 All Medi-Cal PCPs and OBs 2022 IEHP DualChoice Cal MediConnect Plan Benefits 02/10 All Dual Choice IPAs & Providers Medi-Cal Rx Transition: Continuous Glucose Monitors (CGM) UPDATE 02/10 All Medi-Cal IPAs Medi-Cal Rx Transition: Hyaluronic Acid Knee Injections 02/09 All Orthopedic Specialists Medi-Cal Rx UPDATE: Revised Prior Auth Policy for Prescribers and Emergency Fill Quantity Limit 02/07 All Medi-Cal PCPs & Specialists Medi-Cal Rx Transition - How To Assist IEHP Members 02/07 All Medi-Cal PCPs Global Quality P4P IPA Program - 2022 Program Guide Release 02/04 All Medi-Cal IPAs Medi-Cal Letter Templates 02/03 All Medi-Cal IPAs Vaccines for Children: Webinar This Week! 02/02 All IEHP Peds REMINDER: 2022 Global Quality P4P Program – CAIR2 Participation Requirement 02/01 All Medi-Cal IPAs Upcoming CHDP Trainings 02/01 All Medi-Cal PCPs OB/GYN P4P Program Guide- UPDATE 02/01 All Medi-Cal OBs January 2022     2022 Global Quality P4P IPA Kickoff Meeting 01/31 All Medi-Cal IPAs 2022 Global Quality P4P PCP Kickoff Meeting 01/31 All Medi-Cal PCPs Free OTC COVID-19 Antigen Kits Available 01/28 All Medi-Cal PCPs Provider Manual Acknowledgement of Receipt (AOR) Winners! 01/28 All IEHP Providers Home Dialysis Codes S9335 and S9339 01/27 All Dialysis Providers PATH Program Design Webinar 01/26 All Medi-Cal PCPs Free At-Home COVID-19 Tests Available by Request 01/26 All Medi-Cal PCPs Fluoride Application Training Flyer 01/26 All PCPs SB County Black Infant Health Program 01/25 All San Bernardino County PCPs, OBs & BH Providers Medi-Cal Rx Transition - Implantable and Injectable Contraceptives FAQs 01/24 All Medi-Cal PCPs and OBs SAVE THE DATE - Care Management Medi-Cal IPA Training 01/24 All Medi-Cal IPAs COMING SOON - Pyx Health Mobile Application - Pilot Program 01/24 All PCPs and IPAs Participation Required - 2022 Global Quality P4P Program- CAIR2 01/24 All Medi-Cal PCPs Access Standards – Appointment Availability For Specialists 01/20 All Specialists Access Standards – Appointment Availability For PCPs and OBs 01/20 All PCPs & OBs Access Standards – Appointment Availability For Behavioral Health Providers 01/20 All Behavioral Health Providers Clarification! - Individualized Care Plan (ICP) Attestation Process 01/19 All DualChoice Providers Non-Contracted Hospitals Required to Obtain PA for Post-Stabilization Care of IEHP Members 01/19 California Non-Contracted Hospitals Misdirected Claim Outreach Letter V3 01/18 All IEHP Trading Partners Medi-Cal Rx Transition - Implantable and Injectable Contraceptives 01/18 All Medi-Cal PCPs and OBs Medi-Cal Rx (Magellan) Customer Service 01/18 All Medi-Cal PCPs & Specialists Medi-Cal Rx Transition - Continuous Glucose Monitors (CGM) 01/18 All Medi-Cal PCPs & Specialists UPDATE: Community Supports Referral Process 01/14 All Behavioral Health Providers IEHP HOLIDAY - Martin Luther King Jr. Day 01/14 All IEHP Providers & IPAs UPDATE: CDC Quarantine Guidelines 01/12 Skilled Nursing Facilities Last Chance to Win a $50 Gift Card – Submit 2022 Provider Manual Acknowledgement of Receipt (AOR) Today! 01/12 All IEHP Providers REMINDER! Major Organ Transplant (MOT) Authorization Process 01/11 All PCPs, Specialists, IPAs & Hospitals UPDATE: Community Supports Services UM Authorization Guidelines 01/11 IPAs & Behavioral Health Providers NEW: Riverside County Public Health: Protocol for Isolation and Quarantine for the General Public 01/06 All Riverside County PCPs & Specialists Extending SNF COVID-19 Per Diem Rate 01/05 Skilled Nursing Facilities CORRECTION! Medi-Cal Rx: Mail Order for Blood Pressure Monitors and Nebulizers 01/04 All Medi-Cal PCPs & Specialists NEW BENEFIT: Enhanced Care Management 01/02 All Medi-Cal PCPs & IPAs December 2021     Community Supports- Coming January 1, 2022! 12/30 All PCPs, Specialists & Behavioral Health Providers Global Quality P4P Programs- NEW 2022 Program Guide Release 12/30 All Medi-Cal PCPs NEW: Major Organ Transplant (MOT) Authorization Process 12/30 All Hospitals & COEs NEW: Major Organ Transplant (MOT) Authorization Process 12/30 All PCPs, Specialists & IPAs Medi-Cal Rx: Mail Order for Blood Pressure Monitors and Nebulizers 12/30 All Medi-Cal PCPs & Specialists REMINDER: Medi-Cal Rx launches this weekend - January 1, 2022! 12/29 All Medi-Cal PCPs, Specialists and IPAs NEW IEHP Video – Immunity: Why Vaccines Matter 12/29 All IEHP Providers & IPAs CalAIM Expansion to Zip Codes now in IEHP’s Service Area –January 1, 2022 12/22  All Medi-Cal PCPs & IPAs COVID-19 Vaccine Billing for Medicare Advantage Enrollees Effective DOS January 1, 2022 12/22 Direct DualChoice Providers DHCS Retro Hospice Rates 12/22 Hospice Providers Revised/Retired UM Authorization Guidelines 12/20 IPA Administrators & Medical Directors IEHP 2021 - 2022 Holiday Hours 12/17 All IEHP Providers & IPAs DHCS Medi-Cal Rx (Carve Out) and Members’ Preferred Pharmacy 12/17 All Medi-Cal PCPs, Specialists & IPAs COVID-19 Vaccine Incentive Program – Program Guide 12/16 All Medi-Cal PCPs REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested 12/16 All Medi-Cal PCPs Early Start Eligibility Criteria and Referral Process 12/14 All Medi-Cal PCPs Inland Regional Center Eligibility Criteria and Referral Process 12/14 All Medi-Cal PCPs 2021 Global Quality P4P Program- Data Submission Deadlines - PCPs 12/14 All Medi-Cal PCPs 2021 Global Quality P4P Program- Data Submission Deadlines - IPAs 12/14 All Medi-Cal IPAs SBC Children’s Network Safe Sleep Video 12/13 All San Bernardino County Peds, OBs, Family Planning & Community Clinics REMINDER: Medi-Cal Rx launches January 1, 2022! 12/10 All Medi-Cal PCPs, Specialists & IPAs REMINDER: COVID Vaccine Enrollment Survey - Your Response is Requested 12/10 All Medi-Cal PCPs COVID-19 Vaccine Billing for Medicare Advantage Enrollees 12/10 All Medicare IPAs IEHP Recognized for Innovation Five Years in a Row 12/08 All PCPs, Specialists & IPAs Retraction: IEHP’s Quarterly BHT Provider Training 12/03 All Behavioral Health Providers COVID Vaccine Enrollment Survey 12/03 All Medi-Cal PCPs New! Healthy Heart Health Education Classes 12/03 All IEHP PCPs IEHP’s Quarterly BHT Provider Training 12/03 Behavioral Health Treatment Providers New ID Cards for ALL IEHP Members due to Medi-Cal Rx 12/02 All PCPs, Specialists & IPAs IEHP Clean Claim Rules Implementation 12/02 IEHP Trading Partners CDC Encourages COVID Booster Due to Omicron Variant 12/01 All IEHP PCPs COMING SOON - Enhanced Care Management 12/01 All Medi-Cal PCPs November 2021     CLARIFICATION - Global Quality P4P Meeting (for PCPs) -2022 Program Preview 11/30 All Medi-Cal PCPs Medi-Cal Rx to launch January 1, 2022! 11/30 Medi-Cal PCPs, Specialists & IPAs IEHP Care Management Medicare IPA Training – December 8, 2021 11/29 All Medicare IPAs UM Authorization Guidelines Updates - Revised/Retired/Reviewed with No Changes 11/24 IPA Administrators & Medical Directors Update - Global Quality P4P Meeting (for PCPs) - 2022 Program Preview 11/19 All IEHP PCPs Thanksgiving Day Holidays 11/19 All IEHP Providers & IPAs New “Quality Insights” Reports Available 11/18 Direct DualChoice Providers Save the Date - IEHP’s Quarterly BH Provider Training 11/18 Behavioral Health Providers UPDATE! COVID-19 Vaccine FQHC, RHC and IHF Incentive Program 11/17 IEHP Medi-Cal Indian Health Facilities (IHFs) 2nd Session Added - 2021 Global Quality P4P Update Meeting for PCPs 11/12 All Medi-Cal PCPs Response Requested: Survey - IEHP Claim Misdirect Notification Enhancement 11/11 IEHP Trading Partners Health Care Worker Vaccine Requirements 11/11 All IEHP Providers and IPAs Three Upcoming Webinars on Building COVID-19 Vaccine Trust 11/09 All Medi-Cal PCPs & Medi-Cal IPAs NEW: Submit Historical Supplemental Data Online! 11/09 All Medi-Cal PCPs & Medi-Cal IPAs Expansion of Recall of LeadCare Blood Lead Tests Due to Risk of Falsely Low Results 11/08 All Medi-Cal PCPs & Medi-Cal IPAs October 2021     Drawing for a $50 Gift Card – Submit 2022 Provider Policy and Provider Manual Acknowledgement of Receipt (AOR) 10/29 All IEHP Providers Reminder! - Hospital Discharge Summary Requirements 10/26 Hospitals Reminder! - SNF Discharge Summary Requirements 10/26 Skilled Nursing Facilities DHCS 60 Day Advance Notice to IEHP Members about Medi-Cal Rx 10/26 All Medi-Cal PCPs, Specialists & IPAs Help Protect Your Members Against the Flu 10/25 All PCPs & IPAs Human Papillomavirus (HPV) Vaccination Webinar 10/22 All Medi-Cal PCPs 2021 COVID-19 Vaccination Member Incentive 10/22 All Medi-Cal PCPs NEW!!! COVID-19 Vaccine FQHC and RHC Incentive Program 10/22 All FQHCs & RHCs Medicare Advantage Telehealth Services 10/21 All DualChoice PCPs 2021 Global Quality P4P Update Meeting for IPAs 10/21 All Medi-Cal IPAs 2021 Global Quality P4P Update Meeting for PCPs 10/21 All Medi-Cal PCPs REMINDER: Phase 4 Provider Relief Funding (PRF) – Application Deadline is October 26, 2021! 10/20 All IEHP Providers & IPAs COVID-19 Treatment – RUHS Monoclonal Antibody Treatment Center 10/19 All IEHP Providers & IPAs Health Access License Surrender 10/19 All IEHP Providers & IPAs CANCELLED (and will be rescheduled): 2021 Global Quality P4P Update Meeting for PCPs 10/15 All Medi-Cal PCPs CANCELLED (and will be rescheduled): 2021 Global Quality P4P Update Meeting for IPAs 10/15 All Medi-Cal IPAs Reminder - NEW COVID-19 Vaccine PCP Incentive Program - Kickoff Meeting 10/12 All Medi-Cal PCPs Billing Error: HIPPS Medicare Code Billed for Medi-Cal Members 10/12 All Skilled Nursing Facilities DHCS Frequency Codes Required – UB-04 Box 4 10/11 All Ancillary Providers ICD-10-CM Risk Adjustment Code Changes for CMS HCC Code Capture 10/07 Direct DualChoice Providers Global Quality P4P Programs- Hba1c Measure Coding Guidance 10/07 Medi-Cal PCPs Flu Vaccine Notice: Access to Pharmacy Vaccine Network 10/06 All IPAs, PCPs, Specialists NEW COVID-19 Vaccine PCP Incentive Program- Kickoff Meetings 10/06 Medi-Cal PCPs 2021 Global Quality P4P Update Meeting for PCPs Participants 10/04 IEHP – Global Quality P4P PCP Participants New COVID-19 Vaccine PCP Incentive Program 10/04 All IEHP Medi-Cal PCPs & IPAs You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Provider Manuals - General Information

EHP's contracted Providers understand how IEHP functions and understand the rules and regulations IEHP must comply with, as governed by the California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). The Delegate or Provider has the responsibility to ensure review, understanding, and attestation of the information contained in the Manual. Acknowledgement of Receipt (AOR) 2023 Providers: 2023 Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox 2023 Hospital & IPA AORs For more information regarding 2023 Manuals, click here. 2022 Providers: 2022 Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox 2022 Hospital & IPA AORs For more information regarding 2022 Manuals, click here.

Provider Resources - Forms

liance Delegation Oversight Audit (DOA) Grievance Growth Chart Health and Wellness Historical Data Form Inland Regional Center Medi-Cal Letter Templates Medicare-Medicaid Plan Letter Templates Medicare Non-Contracted Providers Perinatal Pharmacy Provider Preventable Conditions (PPC) Staying Healthy Assessment UM/CM Vision Other Behavioral Health ABA 6 Month and Exit Progress Report Template (Word) ABA FBA Report Template (Word) ABA Service Hour Log (Word) ABA School BHT Services Request Form (Word) Authorization Release of Information Form - English (PDF) Authorization Release of Information Form - Spanish (PDF) Behavioral Health Authorization Request Form (PDF) BHT Social Skills Template (Word) Coordination of Care Treatment Plan Form (PDF) No Further Treatment Request Form (PDF) Psych Testing Battery Plan (for Psychologist use only) (PDF)  Claims For Integrated Denial Notices please click here. Please select on the links below to obtain the revised CMS 1500 form (version 02/12) and the CMS 1500 Reference Instruction Manual. Provider Identified Overpayment Form (PDF) Provider Identified Overpayment Form (Multiple) (PDF) Provider Dispute Resolution (PDR) (PDF) Claims Project Spreadsheet (Excel) Clean Claim Tool Guide - UB04 Inpatient Form (PDF) Clean Claim Tool Guide - UB04 Outpatient Form (PDF) Waiver of Liability Statement - Cal MediConnect Plan (PDF) Revised CMS 1500 Health Insurance Claim Form (PDF) CMS 1500 Reference Instruction Manual (PDF) (Back to top) Compliance Member Incentive Forms Focus Group Incentive (FGI) - Request for Approval Form (PDF) Focus Group Incentive (FGI) - Evaluation Form (PDF) Member Incentive (MI) Program - Request for Approval (PDF) Member Incentive (MI) Program - Annual Update/End of Program Evaluation (PDF) Survey Incentive (SI) - Request for Approval Form (PDF) Survey Incentive (SI) - Evaluation Form (PDF) Nondiscrimination Language Nondiscrimination Language Access Notice: Medi-Cal (PDF) Medicare (PDF) (Back to top) Delegation Oversight Audit (DOA) Biographical Information Sheet Credentialing DOA Audit Tool HIPAA Security - Medi-Cal DOA HIPAA Security - Medicare Medi-Cal DOA Tool UM/CM/QI Medicare DOA Tool UM/CM/QI Medi-Cal UM Referral Template Sub-Contracted Facility/Agency Services and Delegated Functions (Back to top) Grievance The Grievance Forms below are for your Member's use when filing a complaint, or has an appeal regarding any aspect of care or service provided by you. Please select the Appeal and Grievance form appropriate for their use: Medi-Cal Form      English (PDF)     Spanish (PDF) Medicare Form      English (PDF)     Spanish (PDF) (Back to top) Growth Chart Inland Empire Health Plan (IEHP) offers you easy access to useful reference materials and forms you may need. It's just one click away. Select the growth chart form that you need by clicking on the link below: (0-36 months): Head Circumference-For-Age And Weight- For-Length Percentiles           Boys (PDF)          Girls (PDF) (0-36 months): Length and Weight-For-Age Percentiles           Boys (PDF)          Girls (PDF) (2-20 years): Stature and Weight-For-Age-Percentiles           Boys (PDF)         Girls (PDF) (2-20 years): Body Mass Index For-Age Percentiles           Boys (PDF)          Girls (PDF) (Back to top) Health and Wellness DPP Rx Pad (PDF) (Back to top) Historical Data Form Historical Data Form (PDF) (Back to top) Inland Regional Center Early Start (0-36 months) Referral (PDF) Early Start Online Application Eligibility and Intake IRC Referrals (3-99+ years): San Bernardino County: For Providers - (909) 890-4711 // Intake - (909) 890-3148 Riverside County: For Providers - (909) 890-4763 // Intake - (951) 826-2648 (Back to top) Medi-Cal Letter Templates A complete template includes all documents listed under each template in the order specified listed. Changes can only be made to highlighted areas, any changes made outside of the highlighted areas are strictly prohibited by DHCS. Click on the title to expand the menu and download desired document. Carve-Out Template English Last Updated: 10/18/2017   Spanish Last Updated: 10/18/2017   Chinese Last Updated: 01/13/2022   Vietnamese Last Updated: 01/13/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Member Authorization Letter English Last Updated: 09/20/2022 Spanish Last Updated: 09/20/2022   Chinese Last Updated: 09/20/2022   Vietnamese Last Updated: 09/20/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Continuity of Care Authorization Letter English Last Updated: 09/20/2022   Spanish Last Updated: 09/20/2022   Chinese Last Updated: 09/20/2022   Vietnamese Last Updated: 09/20/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Notice of Action Taken - Denied English Last Updated: 10/18/2017   Spanish Last Updated: 10/18/2017   Chinese Last Updated: 01/13/2022   Vietnamese Last Updated: 01/13/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Notice of Action Taken - Modified English Last Updated: 10/18/2017   Spanish Last Updated: 10/18/2017   Chinese Last Updated: 01/13/2022   Vietnamese Last Updated: 01/13/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Notice of Action Taken - Terminated English Last Updated: 10/18/2017   Spanish Last Updated: 10/18/2017   Chinese Last Updated: 01/13/2022   Vietnamese Last Updated: 01/13/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Other Health Care Coverage Requesting Provider Letter English Last Updated: 03/17/2021   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Continuity of Care Terminate Letter English Last Updated: 09/20/2022   Spanish Last Updated: 09/20/2022   Chinese Last Updated: 09/20/2022   Vietnamese Last Updated: 09/20/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Specialist Termination Letter English Last Updated: 09/20/2022   Spanish Last Updated:09/20/2022   Chinese Last Updated:09/20/2022   Vietnamese Last Updated:09/20/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 Prior Authorization Not Required English Last Updated: 09/20/2022   Spanish Last Updated:09/20/2022   Chinese Last Updated:09/20/2022   Vietnamese Last Updated:09/20/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated July 1, 2022 (Back to top) Medicare-Medicaid Plan Letter Templates A complete template includes all documents listed under each template in the order specified listed. Changes can only be made to highlighted areas, any changes made outside of the highlighted areas are strictly prohibited by CMS. Click on the title to expand the menu and download desired document. Carve-Out Information Letter English Last Updated: 11/12/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Denial Reason Matrix English Last Updated: 07/03/2018   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Detailed Explanation of Non-Coverage English Last Updated: 12/17/2021   Spanish Last Updated: 12/17/2021   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Detailed Notice of Discharge English Last Updated: 12/17/2021   Spanish Last Updated: 12/17/2021   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Expedited Criteria Not Met English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Extension Needed for Additional Information English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Integrated Denial Notice - Part B Drugs - 7 day appeal - IPA English Last Updated: 02/14/2022   Spanish Last Updated: 02/14/2022   Chinese Last Updated: 02/14/2022   Vietnamese Last Updated: 02/14/2022   Independent Medical Review - [English] [Spanish] [Chinese] [Vietnamese] Updated May 12, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Integrated Denial Notice - Part C - 30 day appeal - IPA English Last Updated: 03/08/2022   Spanish Last Updated: 02/14/2022   Chinese Last Updated: 02/14/2022   Vietnamese Last Updated: 02/14/2022   Independent Medical Review - [English] [Spanish] [Chinese] [Vietnamese] Updated May 12, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Integrated Denial of Payment Notice - 7 day appeal - IPA English Last Updated: 03/17/2021   Spanish Last Updated: 10/18/2021   Independent Medical Review - [English] [Spanish] [Chinese] [Vietnamese] Updated May 12, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Integrated Denial of Payment Notice - 30 day appeal - IPA English Last Updated: 03/17/2021   Spanish Last Updated: 04/12/2017   Independent Medical Review - [English] [Spanish] [Chinese] [Vietnamese] Updated May 12, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Notice of Authorization of Services English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/17   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Notice of Dismissal of Coverage English Last Updated:03/10/2022   Spanish Last Updated:03/10/2022   Chinese Last Updated:03/10/2022   Vietnamese Last Updated:03/10/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Notice of Medicare Non-Coverage English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021 Notice of Reinstatement of Coverage English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated January 1, 2021   (Back to top) Medicare Certificates of Medical Necessity (CMN) & DME Information Forms (DIF) Positive Airway Pressure Devices for Obstructive Sleep Apnea (PDF) Enteral and Parenteral Nutrition (PDF) External Infusion Pump (PDF) Osteogenesis Stimulators (PDF) Oxygen (PDF) Seat Lift Mechanisms (PDF) Continuation Form (PDF) Transcutaneous Electrical Nerve Stimulator (TENS) (PDF) Pneumatic Compression Device (PDF) (Back to top) Non-Contracted Providers To submit a referral to IEHP, please fill out the referral form below, include all clinical notes and fax it to IEHP. If you are referring back to yourself, please indicate such. If you need IEHP to direct the referral, please indicate that on the form. Referral Authorization Request Form - Non-Contracted Providers (PDF) If you are interested in becoming a network Provider, please click here. (Back to top) Perinatal IEHP provides standard risk assessment forms that can be used by all Providers of obstetrical (OB) services. Please refer to IEHP Provider Policy 10D1, "Obstetrical Services, Guidelines for Obstetrical Services" for further detail. To obtain copies, simply click on the links below. Edinburgh Postnatal Depression Screening Tool - English (PDF) Edinburgh Postnatal Depression Screening Tool - Spanish (PDF) ACOG Antepartum Record (PDF) (Back to top) Pharmacy Click here for Pharmacy forms. (Back to top) Provider Preventable Conditions (PPC) By clicking on these links, you will be leaving the IEHP website. On May 23,2017, the Department of Healthcare Services (DHCS) released All Plan Letter (APL) 17-009, reporting requirements related to Provider Preventable Conditions. In conjunction, DHCS released Dual Plan Letter (DPL) 17-002. As part of these instructions, the Health Plan, Network Providers, Delegates, Contracted Hospitals, and ambulatory surgical centers must report using PPC Form on DHCS secure online portal for both Medicare and Medi-Cal lines of business. Further information is available on the following pages: Instructions for Completing Online Reporting of PPCs Medi-Cal Guidance on Reporting Provider-Preventable Conditions Frequently Asked Questions All Plan Letter (APL) 17-009 Duals Plan Letter (DPL) 17-002 PPC Form Medicare and Medi-Cal lines of business must follow the instructions below: Providers are REQUIRED to send a copy of the completed PPC submission from the DHCS secure online portal to IEHP by fax at (909) 890-5545 within five (5) business days of reporting to DHCS; IEHP does not pay Provider claims nor reimburse a Provider for a PPC, in accordance with 42 CFR Section 438.3(g) and IEHP's three-way Cal MediConnect contract. Per IEHP policy and the Coordinated Care Initiative 3-Way Contract, IEHP reserves the right to recover or recoup any claim related to a PPC; As outlined in both the APL/DPL - Reporting Requirements related to Provider Preventable Conditions, the following classify as PPCs and must be reported: Category 1 - HCACs (For Any Inpatient Hospital Setting in Medicaid) Any unintended foreign object retained after surgery A clinically significant air embolism An incidence of blood incompatibility A stage III or stage IV pressure ulcer that developed during the patient's stay in the hospital A significant fall or trauma that resulted in fracture, dislocation, intracranial injury, crushing injury, burn, or electric shock A catheter-associated urinary tract infection Vascular catheter-associated infection Any of the following manifestations of poor glycemic control: diabetic ketoacidosis; nonketotic hyperosmolar coma; hypoglycemic coma; secondary diabetes with ketoacidosis; or secondary diabetes with hyperosmolarity A surgical site infection following: Coronary artery bypass graft (CABG) - mediastinitis Bariatric surgery; including laparoscopic gastric bypass, gastroenterostomy, laparoscopic gastric restrictive surgery Orthopedic procedures; including spine, neck, shoulder, elbow Cardiac implantable electronic device procedures Deep vein thrombosis/pulmonary embolism following total knee replacement or hip replacement with pediatric and obstetric exceptions Latrogenic pneumothorax with venous catheterization A vascular catheter-associated infection Category 2 - Other Provider Preventable Conditions (For Any Health Care Setting) Wrong surgical or other invasive procedure performed on a patient Surgical or other invasive procedure performed on the wrong body part Surgical or other invasive procedure performed on the wrong patient (Back to top) Staying Healthy Assessment PCPs are responsible for assuring the Staying Healthy Assessment (SHA) Questionnaire is administered during the Initial Health Assessment to each IEHP Member within 120 days of the Member's enrollment. The SHA Questionnaire is available in over nine different languages and in nine separate age categories.  Printed English and Spanish versions are available through your IPA or you can get the forms you need by using the menu below. Please see the PDFs below in the language of your choice. 7098 A    0-6 Months  Select Language: English, Spanish, Arabic, Armenian, Chinese, Hmong, Korean, Russian, Tagalog, Vietnamese 7098 B    7-12 Months  Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 C    1-2 Years Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 D    3-4 Years Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 E    5-8 Years Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 F    9-11 Years Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 G    12-17 Years Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 H    Adult Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese 7098 I    Senior  Select Language: English, Spanish, Arabic, Armenian, Chinese,  Hmong, Korean, Russian, Tagalog, Vietnamese (Back to top) UM/CM Acute Hospital Discharge Needs Request Form (PDF) Authorization for Use and/or Disclosure of Patient Health Information - English (PDF) Authorization for Use and/or Disclosure of Patient Health Information - Spanish (PDF) Care Management Referral Form (PDF) Consent for HIV Test - English (PDF) Consent for HIV Test - Spanish (PDF) Health Risk Assessment (HRA) - IEHP DualChoice - English (PDF) Health Risk Assessment (HRA) - IEHP DualChoice - Spanish (PDF) HIV Testing Sites - Riverside and San Bernardino (PDF) Home Health Check Off List (PDF) Long Term Care (LTC) Data Sheet (PDF) Non-Emergency Medical Transportation (NEMT) Physician Certification Statement (PCS) (PDF) Pain Assessment and Treatment Plan Form (PDF) Referral Form (PDF) Service Request for Skilled Nursing Facilities (PDF) SNF Initial Review (PDF) SNF Follow-up Review (PDF) Standing Referral and Extended Access Referral to Specialty Care (PDF) Sterilization Consent Form PM-330 PM-330 Form - Tips and Example (PDF) PM-330 Form - English (PDF) PM-330 Form - Spanish (PDF) Transportation Requests Form (SNF & LTC) (PDF) Transportation Requests Form (Hospital) (PDF) Wound Assessment - Admission (PDF) Wound Assessment - Follow - Up (PDF) Wound Assessment - Addendum (PDF) (Back to top) Vision Ophthalmologist Referral Form (PDF) Vision Exception Request (VER) Form (PDF) PCP Vision Report Form (PDF) IEHP Lab Form (PDF) Medi-Cal Non-Covered Services/Materials Waiver Form-English (PDF) Medi-Cal Non-Covered Services/Materials Waiver Form-Spanish (PDF) Medi-Cal Non-Covered Services/Materials Waiver Form-Chinese (PDF) Medi-Cal Non-Covered Services/Materials Waiver Form-Vietnamese (PDF) DualChoice Non-Covered Services/Materials Waiver Form-English (PDF) DualChoice Non-Covered Services/Materials Waiver Form-Spanish (PDF) DualChoice Non-Covered Services/Materials Waiver Form-Chinese (PDF) DualChoice Non-Covered Services/Materials Waiver Form-Vietnamese (PDF) (Back to top) Other Authorization of Release - Use & Disclosure of PHI - English (PDF) Authorization of Release - Use & Disclosure of PHI - Spanish (PDF) CMS 1696 Appointment of Representative - English (PDF) CMS 1696 Appointment of Representative - Spanish (PDF) Contracts Maintenance Request Form (PDF) Provider Services Materials Request Form (PDF) 2017 Model Output Report (MOR) Data File Layout (PDF) (Back to top) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Advisory Committees - IECCI Advisory Committee

d out how to join.  Inland Empire Coordinated Care Initiative Advisory Committee To engage stakeholders in the Coordinated Care Initiative, we have created the Inland Empire Coordinated Care Stakeholder Advisory Committee. Goal  The goal of the committee is to maximize information exchange both to and from the community. This community includes key providers, county agencies, and non-profit community agencies serving people with Medicare and Medi-Cal. Membership The following organizations will make up the advisory committee: IEHP Molina County Agencies In-home Support Services (IHSS) Multipurpose Senior Services Program (MSSP) Behavioral/Mental Health Community Based Adult Services (CBAS) Providers IHSS Public Authority Consumers Independent Living Centers Disability Advocacy Organizations Structure IEHP will also utilize three existing stakeholder workgroups, including the Inland Empire Disability Collaborative (IEDC), the Provider Advisory Committee (PAC), and the Persons with Disabilities Workgroup (PDW), and a new member advisory group called the Public Policy Participation Committee (PPPC) for Dual Eligibles. Stakeholder’s feedback from the IEDC, PAC, PDW and PPPC for Dual Eligibles will be presented to the Inland Empire Coordinated Care Stakeholder Advisory Committee and vice versa. Meeting Schedule:  Tentative Dates March 15, 2022 May 17, 2022 July 19, 2022 September 20, 2022 November 15, 2022 Virtual Meeting Details: Phone Number: (844) 621-3956 Meeting Number (access code): 2464 696 4328 Click here to join the meeting. Meeting Password:  pHvEA56ukW5 (dial 74832568 from your phone)

Governing Board Meetings - Agenda and Reports

will now be held at the following address: Dr. Bradley P. Gilbert Center for Learning & Innovation 9500 Cleveland Ave. Rancho Cucamonga, CA 91730 Click here to view the meeting room map. Any Member of the public may observe the scheduled proceedings by using the link listed below. September 12, 2022 - 9 a.m. Click here to join the virtual meeting. October 2022 Agenda Board Report Under $200k Summary Report September 2022 Agenda Board Report Under $200k Summary Report

Pharmacy Communications - Pharmacy Communications

or later to view the PDF files. You can download a free copy by clicking here. By clicking on this link, you will be leaving the IEHP website. TITLE DATE RECIPIENTS September 2022     Recalls, Withdrawals & Safety Alerts 09/08 All IEHP Pharmacy Providers August 2022     2022-2023 Flu Vaccination for IEHP Members 08/31 All IEHP Pharmacy Providers Reminder: Medi-Cal Rx Gradual Reinstatement of PAs - Phase 1 08/31 All IEHP Pharmacy Providers 30-Day Countdown: Reinstatement of PA Requirements for 11 Drug Classes 08/18 All IEHP Pharmacy Providers 30-Day Countdown: Reinstatement of PA Requirements for 11 Drug Classes 08/17 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 08/10 All IEHP Pharmacy Providers July 2022     Academic Detailing Services Now Offered 07/15 All IEHP Pharmacy Providers DHCS Medi-Cal Rx Update: Postponement of Implementation of NCPDP Reject Code 80 07/13 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 07/07 All IEHP Pharmacy Providers June 2022     New DHCS DUR Board Educational Article 06/22 All IEHP Pharmacy Providers MTM Medicare Pharmacy Mailing Campaign 06/08 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 06/05 All IEHP Pharmacy Providers Academic Detailing Services Now Offered 06/04 All IEHP Pharmacy Providers Medi-Cal Rx Transition: Blood Pressure Monitors and Cuffs 06/03 All IEHP Pharmacy Providers Important Notice: COVID-19 Oral Antivirals Billing 06/01 All IEHP Pharmacy Providers May 2022     Recalls, Withdrawals & Safety Alerts 05/05 All IEHP Pharmacy Providers April 2022     Rejected Claims Due To Prescriber Error Codes 04/06 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 04/05 All IEHP Pharmacy Providers MTM COVID-19: Test to Treat 04/04 All IEHP Pharmacy Providers March 2022     MTM Medicare Pharmacy Mailing Campaign 03/29 All IEHP Pharmacy Providers New DHCS DUR Board Educational Article 03/16 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 03/28-03/31 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 03/21-03/25 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 03/14-03/18 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 03/07-03/11 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 03/07 All IEHP Pharmacy Providers IEHP Contracted DME Pharmacies: CGM, BP Monitor, Nebulizer 03/02 All IEHP Pharmacy Providers February 2022     Medi-Cal Rx Transition: How To Assist IEHP Members 02/28-03/04 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 02/22-02/25 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 02/14-02/18 All IEHP Pharmacy Providers Medi-Cal Rx Transition: How To Assist IEHP Members 02/10-02/11 All IEHP Pharmacy Providers Pharmacy Empowerment Program 02/08 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 02/07 All IEHP Pharmacy Providers New DHCS DUR Board Educational Article 02/02 All IEHP Pharmacy Providers January 2022     Free OTC COVID-19 Antigen Test Kits Available 01/31 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 01/17-01/21 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 01/10-01/14 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 01/07 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 01/05 All IEHP Pharmacy Providers December 2021     Medi-Cal Rx Transition Implementation 12/27-12/30 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 12/20-12/23 All IEHP Pharmacy Providers IMPORTANT NOTICE: COVID-19 Vaccine Billing 12/20 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 12/13-12/17 All IEHP Pharmacy Providers Notice of High-Risk Medications Drug Alternative(s) Reference Guide- New 2019 Update to the AGS Beers Criteria 12/10 All IEHP Pharmacy Providers Medi-Cal Rx Transition: Blood Pressure Monitors and Nebulizers 12/10 All IEHP Pharmacy Providers Medi-Cal Rx Transition Implementation 12/09-12/10 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 12/08 All IEHP Pharmacy Providers November 2021     Furnishing Narcan (naloxone) 11/09 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts 11/03 All IEHP Pharmacy Providers Reporting Opioid Claim Related Safety Edit Errors 11/01 All IEHP Pharmacy Providers October 2021     Recalls, Withdrawals & Safety Alerts 10/28 All IEHP Pharmacy Providers New DHCS DUR Board Educational Article 10/13 All IEHP Pharmacy Providers Rejected Claims due to Member Eligibility Issues to be Reprocessed 10/05 All IEHP Pharmacy Providers  

Pharmacy Services - Pharmacy Network Lists

here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.     IEHP DualChoice Home Infusion Pharmacy Network List (PDF) IEHP DualChoice Indian/ Tribal/ Urban Indian Pharmacy Network List (PDF) IEHP DualChoice Long Term Care Pharmacy Network List (PDF) IEHP DualChoice Mail Order Pharmacy Network List (PDF) IEHP DualChoice Retail & Chain Pharmacy Network List (PDF) 2022-2023 IEHP DualChoice Vaccine Pharmacy Network (PDF)   Information on this page is current as of September 22, 2022.

Medi-Cal Rx Transition

he pharmacy benefit for IEHP Members. Prescription medications for IEHP Members will be covered by “Medi-Cal Rx”. Bring both your Medi-Cal ID Card and IEHP ID card to the pharmacy when you pick up your prescriptions to avoid delays.  What is changing with my pharmacy benefit? Starting on January 1, 2022, you will get your Medi-Cal covered prescriptions through Medi-Cal Rx instead of IEHP. DHCS is working with a new contractor, Magellan Medicaid Administration, Inc. to provide pharmacy services. Will the cost of my medicines change? There will be no change in how you pay for your medicines. What do I need to do? Most people do not need to do anything. Your Doctors are being notified about the change. Will I need to change my medicines? Most people will not have to change their medicines. You will need to check the list of medicines covered by Magellan. The list of drugs that require prior approval may be different than the list IEHP uses. Your Doctor may need to get approval to refill prescriptions. He or she may talk to you about changing to a medicine that does not require prior approval. Will my pharmacy change? Most pharmacies will accept your new coverage. You can call the Medi-Cal Member Help Line (1-800-541-5555, TTY 1-800-430-7077) to ask if your pharmacy will accept Medi-Cal Rx. If your pharmacy does not work with Medi-Cal Rx, you may need to choose another pharmacy. What if I need help finding a pharmacy? The Medi-Cal Rx Pharmacy Locator online at www.Medi-CalRx.dhcs.ca.gov will be available in December 2021. Or starting on January 1, 2022, you can call Customer Service at 1-800-977-2273 24 hours a day, seven days a week or 711 for TTY Monday thru Friday, 8am to 5pm. What happens now? You will receive a new IEHP Member Card with the Magellan phone number. Always bring your IEHP Member Card and your Medi-Cal Benefits Identification Card (BIC) with you to your pharmacy. What if I have more questions? On or Before December 31, 2021 If you have questions about this notice or have Medi-Cal Rx general questions, contact the Medi-Cal Member Help Line (1- 800-541-5555, TTY 1-800-430- 7077), Monday thru Friday, 8am to 5pm.  On or After January 1, 2022 You can call the Medi-Cal Rx Call Center Line (1-800-977-2273) 24 hours a day, seven days a week, or 711 for TTY, Monday thru Friday, 8am to 5pm. What happens if I have a complaint? Magellan will accept and resolve your complaint. You can submit a complaint either in writing or by telephone. You can only use this website and phone number to file a complaint on or after January 1, 2022. Visit www.Medi-CalRx.dhcs.ca.gov or call Customer Service at 1-800-977-2273. Can I still call IEHP for help with my pharmacy complaints? IEHP will no longer handle complaints for pharmacy services received on or after January 1, 2022. How does the change affect Members with Kaiser Permanente? Members with Kaiser Permanente can still get prescriptions through\ Kaiser-affiliated pharmacies.

P4P - Proposition 56 - GEMT - Prop 56 - Value Based Payment

payment to incentivize Providers for meeting specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas are behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website.  Value Based Payments Program Guide Value Based Payments (VBP) Program Guide (PDF) - Published: January 01, 2022 Value Based Payments Dispute Forms Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: January 19, 2022 Value Based Payments Program - Encounter Dispute Request (PDF) Published: January 19, 2022 Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org At-Risk Condition Codes The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details. At-Risk Condition Codes (PDF) Published: March 25, 2020 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Plan Updates - Updates

alifornia Specific Quality Withhold Technical Notes for DY 2 to 8 (PDF) Core Quality Withhold Technical Notes for DY 2 to 9 (PDF) Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations) What’s New for 2022-2023  By clicking on these links, you will be leaving the IEHP website. The composition of flu vaccines has been updated. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season. The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older. Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose. Preventive Services Immunizations  By clicking on these links, you will be leaving the IEHP website. CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do Immunization Timing 2022 (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.