main content

Search Results For : " CERTIFICATE KAA77788ME0 "

Pages 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Provider Resources - Pharmacy

gram, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information. If you have any questions regarding services provided by the Pharmaceutical Services Department, please feel free to contact the IEHP Pharmacy Department at (909) 890-2049. Pharmaceutical Services

Provider Resources - Claims

d range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link (By clicking on this link, you will be leaving the IEHP website) https://learn.medi-cal.ca.gov/. Medi-Cal Rates and Codes By clicking on these links, you will be leaving the IEHP website. Medi-Cal Rates The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system. Resource: website CPT Codes This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits. Resource: website Alpha-Numeric HCPCS Files These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data. Resource: website ZIP code To Carrier Locality File This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS. Resource: website Medicare Physician Fee Schedule Information on services covered by the Medicare Physician Fee Schedule (MPFS). Resource: website IEHP Fee Schedule IEHP Fee Schedule - December 08, 2020 (PDF) Other Health Coverage (OHC) Coordination of Benefits with Other Health Coverage (OHC) (PDF) Frequently Asked Questions (FAQs) - OHC (PDF)

Care After Hours - Get Care After Hours

hen you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care.  Call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711. 1. Speak to our Nurse  Our Nurse can offer you medical advice on the phone or guide you to get the care you need.  Common reasons to call our Nurse:   Cough Mild stomach ache Mild fever Sore throat Cold or flu Questions about your medicine  Ear ache  Nurse Advice Video 2. Speak to a Doctor Our Nurse may decide you need to talk with a Doctor. If so, our Nurse will connect you with a Doctor for a live phone chat or schedule a virtual visit through an app. 3. Visit an IEHP Urgent Care Clinic Our Nurse may direct you to an Urgent Care Clinic, so you can see a Doctor the same day. Many clinics are open late, weekends and holidays. Some clinics have X-rays and lab tests. We have more than 90 Urgent Care Clinics in our network. For one near you, visit the IEHP Provider Search. Common reasons to visit an Urgent Care Clinic:  Mild sore throat Mild fever Rash Nose bleed Minor trauma Animal or insect bite Asthma (non-critical) Cuts & lacerations Call 911 or go to the nearest Emergency Room (ER) for emergency medical and behavioral health conditions. Don’t wait!   Urgent Care Video

Helpful Information and Resources - Emergency Safety

y when there is a power shutoff or fire. We want to ensure you get the needed care and services to help you during these events. If you are impacted by these events and need help with your durable medical equipment (such as wheelchairs, ventilators, oxygen monitors, etc.) 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. If you need a medicine refill, go to your pharmacy and request a refill. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). How to prepare for an emergency. Public Safety Power Shutoff Alerts A Public Safety Power Shutoff, also called a PSPS, occurs in response to severe weather. Power is turned off to help prevent wildfire and keep communities safe. We encourage you to sign up for alerts so you know when a Public Safety Power Shutoff may occur and when your power is restored.  Click here to sign up.  Medicine Safety Some medicines may need to be stored in a refrigerator to keep their strength, including many liquid medicines. When the power is out for a day or more, throw away any medicines that should be refrigerated, unless the medicines label says otherwise. If a life depends on the refrigerated medicines (for example, insulin), use them only until a new supply is available. Replace all refrigerated medicines as soon as you can. Resources Refrigerated Medicine Storage (PDF) Insulin Storage and Product Switching in an Emergency (PDF) Comparison of Insulins (PDF) Durable Medical Equipment Safety Use the checklist below to prepare for a power outage. Check your backup power equipment frequently to ensure it will function during an emergency. Call your power and water companies about your needs for life-support devices (home dialysis, suction, breathing machines, etc.) in advance of a disaster. Many utility companies keep a “priority reconnection service” list and map of the locations of power-dependent customers for use in an emergency. Ask the customer service department of your utility companies if this service is available. Keep the shut-off switch for oxygen equipment near you so you can get to it quickly in case of emergency. Generator users should operate generators in open areas to ensure good air circulation. Test generators once a month, and take your generator to be serviced at least once a year, to make sure it will work when needed. Create a plan for how to recharge batteries when the power is out. Reference resources below. When power is restored, make sure the settings on your medical device have not changed. Resources Emergency Power Planning for a Durable Medical Equipment Checklist (PDF): this booklet helps you establish a plan to obtain and organize your medical device information.  How to Prepare for and Handle Power Outages for Medical Devices that Require Electricity - FDA Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices: this checklist will help you create a plan for your electric and battery-dependent devices.  Mental Health If you have been impacted by a fire and need mental health, related to stress or grief, call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm (PST), Monday-Friday. TTY users should call 1-800-718-4347. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY). Additional Tips Build or restock your emergency supply kit, including food, water, flashlights, a radio, fresh batteries, first aid supplies and cash. Click here to find local resources that help you build an emergency supply kit.  Identify backup charging methods for phones such as a battery power pack, a car charger and solar battery charger. Learn how to manually open your garage door. Create a plan based off what you can do by yourself and what you will need help with.  Create an emergency contact list.  If you own a backup generator, ensure it is ready to safely operate. Create an emergency action plan that includes evacuation planning for your home, family and pets. Resources https://www.sce.com/wildfire: how to safety prepare for a wildfire https://www.sce.com/wildfire/psps: Power Safety Power Shutoff resources https://prepareforpowerdown.com/: how to prepare for a power shutoff http://www.jik.com: emergency preparedness information prepared by Jule Kiles https://www.readyforwildfire.org/prepare-for-wildfire/get-set/: how to prepare for a wildfire Emergency Supplies Kits for People with Disabilities and Activity Limitations: checklist suggests emergency kit contents including no cost supplies, that you can tailor to your needs and abilities.  Emergency Evacuation Preparedness: Taking Responsibility For Your Safety, A Guide For People with Disabilities and Other Activity Limitation: how to develop plans that integrates people with disabilities and others with access and functional needs.  Emergency Health Information: Savvy Health Care Consumer Series: a guide to develop your emergency health information. Emergency Travel Safety Tips for Overnight Stays: a guide for people with disabilities.  Tips for Emergency Use of Mobile Devices: preparing your device for an emergency. 

Senior Health - Advanced Care Planning

ing is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you. MY LIFE. MY CHOICE. is IEHP’s Advance Care Planning program for IEHP DualChoice Members. The online program helps you fill out Advance Care Directive forms and gives you a place to keep them safe to share with your Doctor. IEHP can also store related documents like Physician Orders for Life-Sustaining Treatment, Living Wills, Health Care Power of Attorney and Do Not Resuscitate forms. MY LIFE. MY CHOICE. is accessible through the IEHP Member Portal. You can easily upload your Advance Care Directives and access them at any time from your home computer or smartphone. You can also share your forms with your family, friends and caregivers by email, SMS and fax. If you get sick and cannot make medical decisions, having these documents lets others know your wishes about medical care. This ensures you get the treatment and medical care you want. You can learn more about Advance Care Planning by accessing MY LIFE. MY CHOICE. through the IEHP Member Portal OR attending an in-person workshop.  Register online: Log in to the Member portal.  Log in to MY LIFE. MY CHOICE. Follow the steps to begin your Advance Care Planning. Register for an in-person workshop: Log in to the Member portal at www.iehp.org. Click the Health & Wellness tab. Choose “Senior Health” for a list of workshops with dates and times. Choose the workshop you want to attend.  For assistance with MY LIFE. MY CHOICE. please call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.

Care After Hours - Emergency Room vs. Urgent Care Clinic

iding between the ER and Urgent Care. For medical advice before visiting the ER or an Urgent Care Clinic, you can call your Doctor or IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711. Note that ERs are open 24 hours a day and many Urgent Care clinics close in the late evening. When Should I Go to the ER? An emergency is when a person could die or be permanently hurt. The ER provides care for critical or life-threatening conditions.   Visit your closest ER or call 911 if you experience: Changes in mental status, such as confusion Chest pain or pressure Coughing or vomiting blood Difficulty breathing or shortness of breath Severe allergic reaction Severe or persistent vomiting or diarrhea Sudden dizziness, weakness or changes in vision Sudden or severe pain Visit Provider Search for listing of emergency room locations near you. When Should I go to an Urgent Care? Go to an Urgent Care Clinic when you need care after hours for non-life-threatening conditions.  Here are some examples of conditions: A common illness like the flu Minor fever or headache Painful sore throat Earache or sinus pain Minor injuries like a sprained ankle Back pain Cuts or small wounds Small burns Rash or minor allergic reactions Nausea Diarrhea Urinary tract infections There are more than 90 clinics in our IEHP network. Many are open late and on weekends. Search Provider Search or call the IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711.

Urgent Care and Medi-Cal

ic of the moment, it may not always be clear where to go to get help. Besides the worry of the injury or illness itself, you may also be thinking, “does Medi-Cal cover urgent care?” Finding an urgent care clinic that takes Medi-Cal is not the only priority. You also need to think about what kind of treatment you need and where to go to get it. Consider the following example: It is a Saturday morning, and you have a severe stomachache and now start to have a fever. You want to get medical treatment as soon as possible but know your Doctor is closed on the weekend. So, you are not sure whether to go to an urgent care clinic or the emergency room. You also want to make sure there are urgent care clinics nearby that accepts Medi-Cal. Yes, many urgent care clinics do accept Medi-cal. At IEHP we have over 90 urgent care clinics in our network that offer Members care afterhours, on weekends and on holidays, when your primary care doctor might be closed. Click here to search for an IEHP urgent care clinic in your area. Now, that you know that urgent care clinics accept Medi-Cal, let’s review when you might need urgent vs emergency care.  Urgent Care vs. Emergency Room  Urgent care is not the same as emergency care. Urgent care centers are for illnesses and injuries that are not life-threatening, yet still require treatment. Some examples include common illness like the flu, minor fever or headache, painful sore throat, earache or sinus pain, back pain, minor injuries like a sprained ankle, etc. Most urgent care centers provide same-day services and usually have shorter waiting times than emergency rooms.   Emergency rooms (ER) are for life-threatening emergencies and accidents where immediate treatment is required. Emergency rooms are open 24 hours a day 7 days a week and provide care for critical or life-threatening conditions. Visit your nearest ER or call 911 if you experience: changes in mental status, such as confusion, chest pain or pressure, coughing or vomiting blood, difficulty breathing or shortness of breath etc.  When to Visit Urgent Care  Urgent care clinics are not a substitute for your regular doctor. When you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care. Many people don’t realize there is a middle ground between a doctor’s visit and a trip to the ER.  Urgent care centers regularly handle a range of medical problems, including: Fevers Dehydration Small wounds  Vomiting/diarrhea Sprains Allergies Bites Cold or flu symptoms Emergency rooms handle life threatening conditions, including:  Head injuries Broken bones Chest pains Breathing difficulties Heart attack Stroke Serious burns Serious bleeding Be Prepared  Does urgent care take medical history into account? Absolutely! Your medical records form an important part of your treatment and follow-up care. As such, we always recommend you are ready with the following details: Information on pre-existing conditions. Details of past surgeries, when you had them, and which hospital and doctors performed them. A list of prescription medications you take, the dosage, and how often you take them.  A list of any over-the-counter medications you take, the dosage, and how often you take them. Any allergies you have. Make sure to bring your IEHP Member Card While nobody likes to think about being in an accident or suffering a sudden illness, it is important to be prepared. Your Doctor understands your health and medical background. Doctors at urgent care clinics will not have access to the same depth of information as your primary doctor, therefore, we recommend you that you follow up with your primary care Doctor after visiting an urgent care.  After-Hour and Urgent Care Services for IEHP Members  If you think you need urgent care, it’s always recommended to call your doctor’s office. If your doctor’s office is closed, you can call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711, or click here to search for an IEHP Urgent Care clinic.   Of course, always call 911 if immediate medical care is needed. At IEHP, we pride ourselves on improving lives by delivering quality and accessible healthcare and will not rest until our communities enjoy optimal care and vibrant health. If you have any questions about your Medi-Cal benefits 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 to learn more.

Medi-Cal Evidence of Coverage Updates

book for the benefit year of January 1, 2022 – December 31, 2022. How to get care Sensitive care Minor consent services You may only get the following services without your parent or guardian’s permission if you are 12 years old or older: Outpatient mental health care for (minors age 12 or older): Sexual assault (no lower age limit) Incest Physical assault Child abuse When you have thoughts of hurting yourself or others (minors age 12 or older) HIV/AIDS prevention/testing/treatment Sexually transmitted infections prevention/testing/treatment Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook. If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care: Pregnancy Family planning/birth control Abortion services For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the IEHP network. You can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Minors can talk to a representative in private about their health concerns by calling the 24/7 at 1-888-244-IEHP (4347) (TTY 711). Benefits and services What your health plan covers This chapter explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask IEHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711). Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information. Some of the basic health benefits IEHP offers are listed below. Benefits with a star ( * ) may need pre-approval. Acupuncture* Acute (short-term treatment) home health therapies and services Adult immunizations (shots) Allergy testing and injections Ambulance services for an emergency Anesthesiologist services Asthma prevention Audiology* Behavioral health treatments* Cardiac rehabilitation Chiropractic services* Chemotherapy & Radiation therapy Cognitive health assessment Dialysis/hemodialysis services Durable medical equipment (DME)* Emergency room visits Enteral and parenteral nutrition* Family planning office visits and counseling (you can go to a non-participating provider) Habilitative services and devices* Hearing aids Home health care* Hospice care* Inpatient medical and surgical care* Lab and radiology* Long-term home health therapies and services* Maternity and newborn care Major organ transplant* Occupational therapy* Orthotics/prostheses* Ostomy and urological supplies Outpatient hospital services Outpatient mental health services Outpatient surgery* Palliative care* PCP visits Pediatric services Physical therapy* Podiatry services* Pulmonary rehabilitation Rapid Whole Genome Sequencing Rehabilitation services and devices* Skilled nursing services Specialist visits Speech therapy* Surgical services Telemedicine/Telehealth Transgender services* Urgent care Vision services* Women’s health services

MediCal Open Access Program - Open Access Program

a better life, and a better future. Many children enter foster care with a list of physical or behavioral health concerns. Due to changing placements, these concerns often go untreated. By speeding up the process to see a Doctor, the Open Access Program makes it simple for your child to get ongoing medical care. No matter where you live in the Inland Empire, your child can see any Doctor in the network. Plus, our program gives your child many services you won’t find with the Regular Medi-Cal system. How Open Access makes it simpler for your child to get healthcare: Your child can see any PCP in our large network. You can switch Doctors any time, for any reason. IEHP will help you find one. Call 1-800-440-IEHP (4347) / TTY (800) 718-4347. The Program gives your Doctor a record of your child’s health history (shots, medicines, checkups) so there’s no guesswork. If you misplaced your IEHP Member ID Card or Beneficiary Identification Card (BIC), an Open Access Doctor can go online and quickly confirm your child’s eligibility. You and your child get extra services at no cost: Keep your child feeling well with no-cost Wellness Programs like asthma or diabetes.  Keep your child safe and healthy and get extras a parent enjoy like an infant car seat, children’s vitamins, and a bicycle helmet. A team helps you care for your child with a chronic illness. Working with your child’s Doctor, we call you, making sure your child gets the right care. We even lend a hand if things like Doctor visits, lab tests or medicine pile up. Important Resources Open Access Provider Directory (PDF) To get more information about the Open Access Program call an IEHP Foster Care Specialist at (800) 706-4347, Monday–Friday, 8am-5pm. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy. Click Adobe Acrobat Reader. 

Complex Care Management

Do you need help coordinating care with your Doctors? IEHP can help. Our Complex Care Management (CCM) Program was designed to assist Members who are ill. This includes a serious illness, like heart disease, lung disease, kidney disease, AIDS, Hepatitis C, spinal injury or any other chronic uncontrolled condition.  IEHP’s Care Management Team will work with you and your Doctor to make sure you get the care you need. We can help you manage your illness and medicines, coordinate care, work with your Providers and help you to get any needed medical equipment. We also offer and invite you to make use of an Interdisciplinary Care Team (ICT) to help you with your personalized plan of care. This Team consists of your Primary Care Doctor, Complex Care Manager and others who support your health care needs. You may be referred to the CCM program through the following options:  Medical Management Program Referral Discharge Planner Referral Practitioner Referral Caregiver Referral Self-Referral How to opt in to the CCM program First, we will need to complete a health survey with you to assess your needs. This will help determine if you are eligible for the program. If you are eligible for the program and wish to opt in, you will be automatically enrolled.  If you are not eligible for the CCM program but want more information on other Care Management Services available, please contact IEHP Member Services at 1-800-440-4347.  After enrollment into the CCM program, you will be assigned a Primary Case Manager. The Case Manager will contact you at least once every 30 days to discuss your health goals. They will also assist you with a plan to meet those goals.  To get started, 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.  How to opt out of the CCM Program  Once enrolled, you may opt out of the program at any time. Simply contact IEHP Member Services at 1-800-440-4347 and let them know you no longer wish to be involved with the program. Be sure to notify your Case Manager as well.     

Helpful Information and Resources - Personal Injuries and Accidents

l eligible, Please contact the Department of Health Care Services at (916) 445-9891 or visit DHCS.ca.gov/PI. Operating hours: 8am – 12pm and 1pm – 5pm, Monday through Friday. Closed on weekends and holidays. Mailing address: Department of Health Care Services Third Party Liability and Recovery Division Casualty Insurance Section – MS 4720 P.O. Box 997425 Sacramento, CA 95899-7425 IEHP DualChoice (HMO D-SNP) Medicare-Medicaid Plan Members If you are a Medicare Member and would like to report a potential liability settlement, judgment, award or other payment you have received, or to request your Protected Health Information, please click here for Authorization of Release (PDF).  

About Us - Membership

M Members 7K+ Providers 3K+ Team Members

Governing Board - Governing Board

en to the public. View Meeting Agenda and More.

Report an Issue - Report a problem with your care

ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, 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. You can also file a grievance. Ask your Doctor for a form or select from the options below. GRIEVANCE FORM Print and mail grievance form (PDFs are below) Call IEHP Member Services and we will mail you a form If you are mailing your grievance form please send it to: IEHP, Attention: Grievance Dept. P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.   Medi-Cal Member Complaint Form (PDF) IEHP DualChoice (HMO D-SNP) Complaint Form Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.  

Helpful Information and Resources - Holiday Schedule

January 2, 2023 Martin Luther King, Jr. Day - Monday, January 16, 2023 President's Day - Monday, February 20, 2023 Memorial Day - Monday, May 29, 2023 Juneteeth - Monday, June 19, 2023 Day before Independence Day - Monday, July 3, 2023 Independence Day - Tuesday, July 4, 2023 Labor Day - Monday, September 4, 2023 In observance of Veteran's Day - Friday, November 10, 2023 Thanksgiving Day - Thursday, November 23, 2023 Day after Thanksgiving - Friday, November 24, 2023 Christmas Day - Monday, December 25, 2023    

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. All meetings will take place at IEHP headquarters from 12 p.m. - 2 p.m.   2023 Meeting Schedule March 15, 2023 June 21, 2023 September 20, 2023 December 20, 2023  

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 February 8, 2023 May 10, 2023 August 9, 2023 November 8, 2023 Time: 12pm - 2pm

IEHP DualChoice - How to Access Care

ited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which IEHP DualChoice (HMO D-SNP) authorizes use of out-of-network providers. What are Network providers? Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment as payment in full. We have arranged for these providers to deliver covered services to members in our plan. All of our plan participating providers also contract us to provide covered Medi-Cal benefits. Find a Doctor Use the IEHP DualChoice Provider and Pharmacy Directory below to find a network provider: 2023 IEHP DualChoice Provider and Pharmacy Directory (PDF) What is a Primary Care Provider (PCP) and their role in your Plan? A PCP is your Primary Care Provider. You will usually see your PCP first for most of your routine health care needs. Your PCP will also help you arrange or coordinate the rest of the covered services you get as a member of our Plan. "Coordinating" your services includes checking or consulting with other Plan providers about your care and how it is going. This includes: your X-rays laboratory tests, therapies care from doctors who are specialists hospital admissions, and follow-up care Primary Care Providers (PCPs) are usually linked to certain hospitals. When you choose your PCP, remember the following: You must choose your PCP from your Provider and Pharmacy Directory. Call IEHP DualChoice Member Services if you need help in choosing a PCP or changing your PCP. Choose a PCP that is within 10 miles or 15 minutes of your home. The PCP you choose can only admit you to certain hospitals. Try to choose a PCP that can admit you to the hospital you want within 30 miles or 45 minutes of your home. Some hospitals have “hospitalists” who specialize in care for people during their hospital stay. If you are admitted to one of these hospitals, a “hospitalist” may serve as your caregiver as long as you remain in the hospital. When you are discharged from the hospital, you will return to your PCP for your health care needs. If you need to change your PCP for any reason, your hospital and specialist may also change. Your PCP should speak your language. However, your PCP can always use Language Line Services to get help from an interpreter, if needed. If you do not choose a PCP when you join IEHP DualChoice, we will choose one for you. We will send you your ID Card with your PCP’s information. Remember, you can request to change your PCP at any time. You can switch your Doctor (and hospital) for any reason (once per month). If your change request is received by IEHP by the 25th of the month, the change will be effective the first of the following month; if your change request is received by IEHP after the 25th of the month, the change will be effective the first day of the subsequent month (for some providers, you may need a referral from your PCP).  How to Get Care from a Specialist You will usually see your Primary Care Provider (PCP) first for most of your routine healthcare needs such as physical check-ups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group.  It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don't have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. What if you are outside the plan’s service area when you have an urgent need for care? Suppose that you are temporarily outside our plan’s service area, but still in the United States. If you have an urgent need for care, you probably will not be able to find or get to one of the providers in our plan’s network. In this situation (when you are outside the service area and cannot get care from a network provider), our plan will cover urgently needed care that you get from any provider. Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States. Changing your Primary Care Provider (PCP) You may change your PCP for any reason, at any time. Also, it’s possible that your PCP might leave our plan’s network of providers and you would have to find a new PCP. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services. IEHP DualChoice Member Services can assist you in finding and selecting another provider. You can change your Doctor by calling IEHP DualChoice Member Services. Please call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call (800) 718-4347. For more information on network providers refer to Chapter 1 of the IEHP DualChoice Member Handbook. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list.  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader.  Information on this page is current as of October 01, 2022 H8894_DSNP_23_3241532_M

IEHP DualChoice - Prescription Drugs

CMS requirements for pharmacy access in your area. There are over 700 pharmacies in the IEHP DualChoice network. IEHP DualChoice network providers are required to comply with minimum standards for pharmacy practices as established by the State of California. What Prescription Drugs Does IEHP DualChoice Cover? IEHP DualChoice (HMO D-SNP) has a list of Covered Drugs called a Formulary. It tells which Part D prescription drugs are covered by IEHP DualChoice. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The list must meet requirements set by Medicare. Medicare has approved the IEHP DualChoice Formulary.  Find a covered drug below: 2023 Formulary (PDF) 2023 Step Therapy (PDF) 2023 Drugs Requiring Prior Authorization (PDF) Which Pharmacies Does IEHP DualChoice Contract With? Our IEHP DualChoice (HMO D-SNP) Provider and Pharmacy Directory gives you a complete list of our network pharmacies – that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. Generally, you must receive all routine care from plan providers and network pharmacies to access their prescription drug benefits, except in non-routine circumstances, quantity limitations and restrictions may apply.  This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. Limitations, copays, and restrictions may apply. Copays for prescription drugs may vary based on the level of Extra Help you receive. Benefits and copayments may change on January 1 of each year. The List of Covered Drugs and pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. For more information, call IEHP DualChoice Member Services or read the IEHP DualChoice Member Handbook.  2023 IEHP DualChoice Provider and Pharmacy Directory (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy here. By clicking on this link, you will be leaving the IEHP DualChoice website.  If you don’t have the IEHP DualChoice Provider and Pharmacy Directory, you can get a copy from IEHP DualChoice Member Services. At any time, you can call IEHP DualChoice Member Services to get up-to-date information about changes in the pharmacy network. Call IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Out of Network Coverage Generally, IEHP DualChoice (HMO D-SNP) will cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy: What if I need a prescription because of a medical emergency? We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgently needed care. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form. To learn how to submit a paper claim, please refer to the paper claims process described below. Getting coverage when you travel or are away from the Plan’s service area If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time through our network mail order pharmacy service or through a retail network pharmacy that offers an extended supply. If you are traveling within the US, but outside of the Plan’s service area, and you become ill, lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy if you follow all other coverage rules identified within this document and a network pharmacy is not available. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. To learn how to submit a paper claim, please refer to the paper claims process described below. Prior to filling your prescription at an out-of-network pharmacy, call IEHP DualChoice Member Services to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, IEHP DualChoice Member Services may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy. We cannot pay for any prescriptions that are filled by pharmacies outside the United States, even for a medical emergency. What if you are outside the plan’s service area when you have an urgent need for care? When you are outside the service area and cannot get care from a network provider, our plan will cover urgently needed care that you get from any provider. Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States. Other times you can get your prescription covered if you go to an out-of-network pharmacy We will cover your prescription at an out-of-network pharmacy if at least one of the following applies: If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service. If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals). In these situations, please check first with IEHP DualChoice Member Services to see if there is a network pharmacy nearby.  How do you ask for reimbursement from the plan?  If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for IEHP DualChoice's share of the cost. Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records. Mail your request for payment together with any bills or receipts to us at this address:  IEHP DualChoice P.O. Box 4259 Rancho Cucamonga, CA 91729-4259  You must submit your claim to us within 1 year of the date you received the service, item, or drug. Please be sure to contact IEHP DualChoice Member Services if you have any questions. If you don’t know what you should have paid, or you receive bills and you don’t know what to do about those bills, we can help. You can also call if you want to give us more information about a request for payment you have already sent to us. See Chapters 7 and 9 of the IEHP DualChoice Member Handbook to learn how to ask the plan to pay you back. Changes to the IEHP DualChoice Formulary IEHP DualChoice Formulary consists of medications that are considered as first line therapies (drugs that should be used first for the indicated conditions). IEHP DualChoice develops and maintains the Formulary continuously by reviewing the efficacy (how effective) and safety (how safe) of new drugs, compare new versus existing drugs, and develops clinical practice guidelines based on clinical evidence. From time to time (during the benefit year), IEHP DualChoice revises (adding or removing drugs) the Formulary based on new clinical evidence and availability of products in the market.  All the changes are reviewed and approved by a selected group of Providers and Pharmacists that are currently in practice. IEHP DualChoice will give notice to IEHP DualChoice Members prior to removing Part D drug from the Part D formulary. We will also give notice if there are any changes regarding prior authorizations, quantity limits, step therapy or moving a drug to a higher cost-sharing tier. If IEHP DualChoice removes a Covered Part D drug or makes any changes in the IEHP DualChoice Formulary, we will post the formulary changes on IEHP DualChoice website and notify the affected Members at least thirty (30) days prior to effective date of the change made on the IEHP DualChoice Formulary. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market we will immediately remove the drug from our formulary. Some changes to the Drug List will happen immediately. For example: A new generic drug becomes available. Sometimes, a new and cheaper drug comes along that works as well as a drug on the Drug List now. When that happens, we may remove the current drug, but your cost for the new drug will stay the same or will be lower. When we add the new generic drug, we may also decide to keep the current drug on the list but change its coverage rules or limits. We may not tell you before we make this change, but we will send you information about the specific change or changes we made. You or your provider can ask for an “exception” from these changes. We will send you a notice with the steps you can take to ask for an exception. Please see Chapter 9 (What to do if you have a problem or complaint [coverage decisions, appeals, complaints]) of the Member Handbook for more information on exceptions. A drug is taken off the market. If the Food and Drug Administration (FDA) says a drug you are taking is not safe or the drug’s manufacturer takes a drug off the market, we will take it off the Drug List. If you are taking the drug, we will let you know. Your provider will also know about this change. He or she can work with you to find another drug for your condition. We may make other changes that affect the drugs you take. We will tell you in advance about these other changes to the Drug List. These changes might happen if: The FDA provides new guidance or there are new clinical guidelines about a drug. We add a generic drug that is not new to the market and: Replace a brand name drug currently on the Drug List or Change the coverage rules or limits for the brand name drug. When these changes happen, we will tell you at least 30 days before we make the change to the Drug List or when you ask for a refill. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception. Then you can: Get a 31-day supply of the drug before the change to the Drug List is made, or Ask for an exception from these changes. To learn more about asking for exceptions, see Chapter 9 (What to do if you have a problem or complaint [coverage decisions, appeals, complaints]). Again, if a drug is suddenly recalled because it’s been found to be unsafe or for other reasons, the plan will immediately remove the drug from the Formulary. We will let you know of this change right away. Your doctor will also know about this change and can work with you to find another drug for your condition. How will you find out if your drugs coverage has been changed? If IEHP DualChoice removes a covered Part D drug or makes any changes in the IEHP DualChoice Formulary, IEHP DualChoice will post the formulary changes on the IEHP DualChoice website and notify the affected Members at least thirty (30) days prior to effective date of the change made on the IEHP DualChoice Formulary. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market we will immediately remove the drug from our formulary. Getting Plan Approval For certain drugs, you or your provider need to get approval from the plan before we will agree to cover the drug for you. This is called “prior authorization.” Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs. If you do not get this approval, your drug might not be covered by the plan. For additional information on step therapy and quantity limits, refer to Chapter 5 of the IEHP DualChoice Member Handbook. Use the IEHP Medicare Prescription Drug Coverage Determination Form for a prior authorization. Request for Medicare Prescription Drug Coverage Determination (PDF) Model Form Instructions These forms are also available on the CMS website:  Medicare Prescription Drug Determination Request Form (for use by enrollees and providers).  By clicking on this link, you will be leaving the IEHP DualChoice website. Applicable Conditions and limitations We will generally cover a drug on the plan’s Formulary as long as you follow the other coverage rules explained in Chapter 6 of the IEHP DualChoice Member Handbook and the drug is medically necessary, meaning reasonable and necessary for treatment of your injury or illness. It also needs to be an accepted treatment for your medical condition. Here are three general rules about drugs that Medicare drug plans will not cover under Part D: Our plan’s Part D drug coverage cannot cover a drug that would be covered under Medicare Part A or Part B. Our plan cannot cover a drug purchased outside the United States and its territories. Our plan usually cannot cover off-label use. “Off-label use” is any use of the drug other than those indicated on a drug’s label as approved by the Food and Drug Administration. For more information refer to Chapter 6 of your IEHP DualChoice Member Handbook. Getting a temporary supply In some cases, we can give you a temporary supply of a drug when the drug is not on the Drug List or when it is limited in some way. This gives you time to talk with your provider about getting a different drug or to ask us to cover the drug. To get a temporary supply of a drug, you must meet the two rules below: The drug you have been taking: is no longer on our Drug List, or was never on our Drug List, or is now limited in some way. You must be in one of these situations: You were in the plan last year. You are new to our plan. You have been in the plan for more than 90 days and live in a long-term care facility and need a supply right away. When you get a temporary supply of a drug, you should talk with your provider to decide what to do when your supply runs out. Here are your choices: You can change to another drug. There may be a different drug covered by our plan that works for you. You can call Member Services to ask for a list of covered drugs that treat the same medical condition. The list can help your provider find a covered drug that might work for you. OR You can ask for an exception. You and your provider can ask us to make an exception. For example, you can ask us to cover a drug even though it is not on the Drug List. Or you can ask us to cover the drug without limits. If your provider says you have a good medical reason for an exception, he or she can help you ask for one. If a drug you are taking will be taken off the Drug List or limited in some way for next year, we will allow you to ask for an exception before next year. We will tell you about any change in the coverage for your drug for next year. You can then ask us to make an exception and cover the drug in the way you would like it to be covered for next year. We will answer your request for an exception within 72 hours after we get your request (or your prescriber’s supporting statement). Medicare Prescription Drug Coverage and Your Rights Notice- Posting of Member Drug Coverage Rights: Medicare requires pharmacies to provide notice to enrollees each time a member is denied coverage or disagrees with cost-sharing information. You have a right to appeal or ask for Formulary exception if you disagree with the information provided by the pharmacist.  Read your Medicare Member Drug Coverage Rights.   Drug Utilization Management We conduct drug use reviews for our members to help make sure that they are getting safe and appropriate care. These reviews are especially important for members who have more than one provider who prescribes their drugs. IEHP DualChoice (HMO D-SNP) has a process in place to identify and reduce medication errors. We do a review each time you fill a prescription. We also review our records on a regular basis. During these reviews, we look for potential problems such as: Possible medication errors. Drugs that may not be necessary because you are taking another drug to treat the same medical condition. Drugs that may not be safe or appropriate because of your age or gender. Certain combinations of drugs that could harm you if taken at the same time. Prescriptions written for drugs that have ingredients you are allergic to. Possible errors in the amount (dosage) or duration of a drug you are taking. Over-utilization and under-utilization Clinical abuse/misuse If we see a possible problem in your use of medications, we will work with your Doctor to correct the problem. IEHP DualChoice also provides information to the Centers for Medicare and Medicaid Services (CMS) regarding its quality assurance measures according to the guidelines specified by CMS. Information on this page is current as of October 01, 2022 H8894_DSNP_23_3241532_M

Community Resource Centers - About Us

HP Community Resource Centers (CRC) are your local resource for healthcare information in Riverside, San Bernardino and Victorville. Our friendly, bilingual staff can help you take free classes, learn about health care, and about health coverage programs. Our doors are open to IEHP Members and the community.  We Have In-Person and Online Classes Fitness Classes Stay active with classes like Yoga, Zumba (all levels), Tai Chi, Line Dance, Yoga for Seniors & People with Disabilities, Meditation, Aerobic Box, Latin Dance, Strength and Conditioning, and Kid Aerobics. Wellness Classes Learn about nutrition, managing asthma symptoms, controlling diabetes, stress management, breathing and relaxation. Where can I find Classes? In Person: Riverside | San Bernardino | Victorville Online: Virtual Classes Riverside Community Resource Center VIEW OUR MONTHLY RIVERSIDE CRC CALENDAR Click to Download PDF Click Para Descargar PDF Riverside CRC Address: 3590 Tyler Street, Suite 101, Riverside, CA 92503 Riverside CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: San Bernardino CRC Victorville CRC  Virtual/Online  Click to view in Google Maps San Bernardino Community Resource Center VIEW OUR MONTHLY SAN BERNARDINO CRC CALENDAR Click to Download PDF Click Para Descargar PDF San Bernardino CRC Address: 805 West 2nd Street, Suite C, San Bernardino, CA 92410 San Bernardino CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: Riverside CRC Victorville CRC  Virtual/Online  Click to view in Google Maps Victorville Community Resource Center VIEW OUR MONTHLY VICTORVILLE CRC CALENDAR Click to Download PDF Click Para Descargar PDF Victorville CRC Address: 12353 Mariposa Road, Suites C-2 & C-3, Victorville, CA 92395 Victorville CRC Phone: 1-866-228-4347 TTY users should call 711 View Our Other CRC Locations: Riverside CRC San Bernardino CRC Virtual/Online  Click to view in Google Maps Visit our on-site partner agencies for the following services: Goodwill Southern California: A workforce provider helping individuals empower themselves with the skills and job support services they need and want to thrive. Housing Authority of the County of San Bernardino: Affordable housing provider and rental assistance to low-income families via vouchers or affordable housing units. Young Visionaires Youth Leadership Academy: Mentorship enriching lives of young people through life building activities and instruction in the areas of education, employment, health, mentoring, and community service. Community Action Partnership of San Bernardino County: Providing Home Energy Assistance Program (HEAP) and Housing Assistance for San Bernardino County residents. TODEC: Provides legal immigration services, advocacy, community organizing, and civic engagement. Virtual Classes VIEW OUR MONTHLY ONLINE CLASSES CALENDAR Click to Download PDF Click Para Descargar PDF Join the Classes via Facebook: Our Community Resource Centers are now offering virtual classes via Facebook. Join a class today. Join the Classes via WebEx:   Webex Classes (Password: 12345): Apple Users Android Users PC Users