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at you can to protect yourself from the flu virus. Everyone should get the flu shot. Members who are especially high risk for complications are: 65 years of age or older. Pregnant. Residents of nursing homes and long-term care facilities. Children, 6 months or older. Remember, in many cases, the flu shot can prevent the flu, lessen the symptoms if you get the flu and reduce spreading it to others. Common myths about the flu shot Myth 1: I can get the flu from the flu shot. False. The flu shot is made from a virus that is not active, so it doesn’t cause infection. Myth 2: I’m healthy; I don’t need the flu shot. False. Healthy people can get sick, too. Very sick. The flu shot can help lower your chances of getting sick. Myth 3: I got a flu shot last year. I don’t need a shot this year. False. The flu virus changes every year and so does the flu shot. You need a flu shot every year to fight this year's flu.  Frequently Asked Questions Q: Where can I get the flu shot? A: Your Doctor’s office (for adults and children), certain network pharmacies like CVS, Rite Aid and Walgreens (for adults only). Q: What are ways I can avoid getting the flu? A: To avoid getting the flu, you should:   Get the flu shot. Avoid close contact with people who are sick. Wear something to cover your mouth and nose when in public. Wash your hands often with soap and water. If you don't have soap and water, use an alcohol-based hand sanitizer.  Avoid touching your eyes, nose, and mouth.  Eat healthy. Drink lots of fluids, especially water.  Get plenty of rest. Clean and disinfect surfaces around you. Q: What should I do if I get the flu? A: If you get the flu, be sure to: Stay home and rest. Avoid others.  Drink lots of fluids, like water and juice. See your Doctor if symptoms do not improve. If you have the flu but can’t reach your Doctor, call the IEHP 24-Hour Nurse Advice Line at 1-888-244-IEHP (4347) or 711 for TTY users. Our nurses can connect you with a Board-Certified Doctor by telephone or virtual visit via video chat.

Members using text messaging, this form of communication can reach our Members immediately. Although information isn't limited to this common communication channel, we may send you important healthcare notifications to: Inform you on how to get care and services with IEHP Remind you about key preventive care visits to help you stay healthy Let you know about health education and wellness programs that you are eligible for And much more To sign up, Members need to text “Healthy” to 90902. Message and data rates may apply. For help, text HELP to 90902 or email texthelp@iehp.org. Members can unsubscribe by replying STOP at any time. Message frequency varies.  This texting program is available to Members who are the subscribers of Boost, AT&T, T-Mobile®, Dobson, Verizon Wireless, U.S. Cellular, C Spire Wireless, Metro PCS, Cricket Communications, Virgin Mobile and other wireless carriers. Carriers are not liable for delayed or undelivered messages. Members must be 13 years of age or older to use this service. You also agree to IEHP Wireless Text Messaging Terms and Conditions.  We respect your privacy. Our privacy policy can be found here. Contact Info: 10801 Sixth Street Rancho Cucamonga, CA 91730 1-800-440-IEHP (4347) 1-800-718-IEHP (4347) for TTY Users 8AM-5PM PST texthelp@iehp.org www.iehp.org *This short code program is managed by mPulse. www.mpulsemobile.com  

ively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse. Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit. After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken.  Results of consultation with provider and findings will be documented. After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation.  Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation. Member may also be referred for evaluation and monitoring by a pain management specialist.   You will need Adobe Acrobat Reader 6.0 or 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. Resources and Tools: Pain Management CPG (PDF) Pain Quick Reference Guide (PDF) For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website. http://oag.ca.gov/cures-pdmp   Information on this page is current as of January 1, 2022  

here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   To view IEHP’s current Pharmacy Network under IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan, please use this link: Under “How to Access Care” tab, click on “2022 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   To view IEHP’s future Pharmacy Network under IEHP DualChoice (HMO D-SNP), please use this link: Under “How to Access Care” tab, click on “2023 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   Information on this page is current as of November 02, 2022.

th IEHP’s inspiring and compelling Mission to “Heal and Inspire the Human Spirit,” we are mindful of the cost of caring on clinician health and well-being and we want you to know we care about you, stand with you, and want to support you in ways that help you sustain joy in your work. We have provided best-practice and highly respected resources here for provider well-being. May you continue to find purpose and fulfillment in your calling to this very sacred work of health care.   Resources Standford Well MD A robust site of resources, courses, publications, self-assessments, research, innovation, conferences, and trainings. https://wellmd.stanford.edu/   National Academy of Medicine A compilation of key resources for improving clinician well-being. https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/   American Association of Physician Leadership (AAPL) Resources, courses, and tools for Physician Wellness, Physician Leadership, and more. https://www.physicianleaders.org/resources/wellness   Coalition for Physician Wellness Resources, mobile app, research, podcasts, books and publications. https://www.forphysicianwellbeing.org/   Healthcare Burnout Symposium – February 2023 Annual conference that addresses the multiple facets of burnout crisis and how to increase the well-being of physicians, nurses and administrators. Visit website to learn more about conference agenda and how to earn continuing education credits. https://www.stophealthcareburnout.com/   American Medical Association Alliance (AMA) Steps Forward Program: Improving Physician Resilience Resources for physicians to enhance their resiliency and prevent burnout. Visit website to learn more about the AMA’s Steps Forward guide and module. Physicians might be able to earn continuing education credits by completing the training. https://amaalliance.org/physician-burnout/   American College of Physicians Online learning center with webinar and videos available on physician well-being and professional fulfillment. https://www.acponline.org/online-learning-center/physician-well-being-and-professional-fulfillment   Los Angeles County Medical Association (LACMA) Interactive Wellness dashboard and resources for physicians. https://www.lacmainteractive.com/mdlifeline   National Suicide Prevention Hotline The lifeline provides 24/7, free and confidential support, prevention and crisis resources for anyone in need and best practices for professionals in the United States. https://988lifeline.org/   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

IEHP. The network includes approximately 100 representatives from community-based organizations, service agencies, clinics, and schools. Attendees share healthcare news, resources and discuss how to enroll uninsured children in a health program which they qualify for. Most of all — attendees bring their specialty to connect and collaborate on ways to help families in the Inland Empire. How can I join the IEHP Community Partner Network? If you are interested in joining the IEHP Community Partners Network, please email communityhealthreps@iehp.org for information. Click here if your organization is interested in becoming an IEHP Community Partner. When are the meetings held? The following is the schedule for the IEHP Community Partner meetings. 2023 Schedule Thursday, February 16 Thursday, April 20 Thursday, June 15 Thursday, August 17 Thursday, October19 Thursday, December 14 Location: Virtually Time: 11:00am - 12:30pm

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.

pating Network Provider private hospitals through uniform dollar increases for select inpatient and outpatient services based on actual utilization of qualifying services as reflected in encounter data reported to DHCS. PHDP utilization-based payments will be calculated by DHCS in accordance with the CMS approved preprint, and must be issued by IEHP to private hospitals, in six-month increments: January through June, and July through December Enhanced Payment Program (EPP) EPP provides supplemental reimbursement to Network Provider DPHs through uniform dollar increases for select inpatient and non-inpatient services, based on the actual utilization of qualifying services as reflected in encounter data reported to DHCS. In addition, for Network Provider DPHs that are primarily reimbursed on a capitated basis, DPH EPP provides supplemental reimbursement through uniform percentage increases to their contracted capitation rates. EPP utilization-based payments and Capitation based payments will be calculated by DHCS in accordance with the CMS-approved preprint and must be issued by to DPHs, in six-month increments: January through June, and July through December For more information about PHDP and EPP Programs, please visit the DHCS website at https://www.dhcs.ca.gov/services/Pages/DirectedPymts.aspx. District and Municipal Public Hospital Quality Incentive Pool and Designated Public Hospital Quality Incentive Pool QIP provides supplemental incentive payments to participating DPH and DMPH systems based on their performance on specified quality measures that address primary, specialty, and inpatient care, including measures of appropriate resource utilization. QIP payments are linked to delivery of services under MCP contracts. For additional details on QIP incentive program please visit DHCS website at https://www.dhcs.ca.gov/services/Pages/DP-DPH-QIP.aspx or contact DHCS at qip@dhcs.ca.gov. For disputes of payments issued under Private Hospital Directed Payment Program (PHDP) and or Enhanced Payment Program (EPP)- Hospital is to send email to PHDP-EPP@iehp.org stating the service period and dispute reason in detail. Hospital has six months from IEHP’s payment check date to dispute payment. FAQ’s on Hospital Directed Payments Please e-mail any inquiries related to the PHDP or EPP Program to PHDP-EPP@iehp.org.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

BM) handles all Medicare pharmacy and provider prior authorization and pharmacy benefit related questions. Providers and pharmacies can call MedImpact Customer Contact Center at (800) 788-2949. Health care providers can submit prior authorizations via fax (858) 790-7100, or download forms at the MedImpact Website. Request for Redetermination of Medicare Prescription Drug Denial - English (PDF) Request for Redetermination of Medicare Prescription Drug Denial - Spanish (PDF) Coverage Determination Form - Retroactive prior authorization requests (PA requests dated before 1/1/2023) should be faxed to (909) 890-5766.   Drug Request Supplemental PER Form for Compounded Prescription (PDF) Medicare Hospice Form for Medicare Part D Plans (PDF) Medicare Prescription Drug Coverage and Your Rights - English (PDF) Medicare Prescription Drug Coverage and Your Rights - Spanish (PDF) Mail Order Mail-Order Service Fax Form (PDF) Other Pharmacy Provider Forms Appointment of Representative - English (PDF) Appointment of Representative - Spanish (PDF) Nutritional Evaluation Form - Adult (PDF) Nutritional Evaluation Form - Infant (PDF)  Opioid Edit Error Report Form (PDF) WIC Program Forms (California Department of Public Health) Pediatric Referral Form (PDF) WIC Referral For Pregnant Women (PDF) WIC Referral For Postpartum/Breastfeeding Women (PDF)   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. By clicking on this link, you will be leaving the IEHP website.   Information on this page is current as of January 05, 2023.

aboratively with the IEHP Governing Board to set the strategic vision and provide executive leadership for one of the 10 largest Medicaid health plans and the largest not-for-profit Medicare- Medicaid Plan in the U.S.  He cultivates IEHP’s strong partnership with Providers, hospitals and hundreds of community partners to deliver quality whole-person care to more than 1.6 million Members.  

responsible for the overall financial management of IEHP, its financial reporting and transparency, and for multiple plan financial functions, including accounting, purchasing, capitation, cost recovery, risk management and the coordination of fiscal and other operational audits. He also oversees contracting, product system configuration, facilities/property management development and security teams.

advancement of IEHP’s strategic focus on quality through transformative payment incentives, data driven initiatives, innovative solutions, program connections and strong internal and external partnerships. In this role, Dr. Juhn also ensures the health plan’s commitment to providing the highest quality of care.  

2020. She oversees IEHP’s communications and marketing programs and guides the development of long-term communication and marketing strategies.  In this role, Ms. Rai oversees the strategic execution of IEHP’s branding, advertising, media relations, internal communications, digital and social media initiatives to align with IEHP’s Mission, Vision and Values.  

clinical strategic leadership for IEHP in partnership with the Chief Quality Officer through collaborative, accountable processes to improve the quality-of-care delivery and drive improved health outcomes for IEHP Members.  He is responsible for the health services division, including utilization management, behavioral health and care management, pharmacy, community health and health education, population health, health services special initiatives and health equity.   

ork sphere and was appointed Chief Operating Officer (COO) in July 2019. As COO, Susie is responsible for IEHP’s overall day-to-day operations. She is highly regarded for her commitment to driving IEHP’s team culture, serving the plan’s 1.6 million Members and advancing the plan’s Provider experience through the implementation of strategic initiatives that support the plan’s Mission, Vision and Core Values.    

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. 2023 Meeting Schedule March 22, 2023 May 10, 2023 August 30, 2023 November 8, 2023 Time: 12pm - 2pm

e, Mr. Devabhaktuni provides leadership for the overall information technology architecture, as well as the design, development, implementation and support of IEHP’s systems.  His focus includes maintaining the organization’s connection to Providers, collaborating closely with IT leadership, and aligning initiatives with IEHP’s overall strategic plan.  

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.  Inland Empire Health Plan Dates & Times Monday, January 30, 2023 9:00 a.m. February - NO MEETING Monday,  March 6, 2023 9:00 a.m. Monday, April 10, 2023 9:00 a.m. Monday, May 8, 2023 9:00 a.m.  Monday, June 5, 2023 9:00 a.m.  Monday, July 10, 2023 9:00 a.m.  Monday, August 14, 2023 9:00 a.m.  Monday, September 11, 2023 9:00 a.m.  Tuesday, October 10, 2023 9:00 a.m. Monday, November 13, 2023 9:00 a.m.  Monday, December 11, 2023 9:00 a.m. 

, you have the right to: Receive information about your rights and responsibilities as an IEHP DualChoice Member. Be treated with respect and courtesy. IEHP DualChoice recognizes your dignity and right   to privacy. Receive services without regard to race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), disability, genetic information, or source of payment.  Receive information about IEHP DualChoice, its programs and services, its Doctors, Providers, health care facilities, and your drug coverage and costs, which you can understand. Have a Primary Care Provider who is responsible for coordination of your care. If your Primary Care Provider changes, your IEHP DualChoice benefits and required co-payments will stay the same. Your IEHP DualChoice Doctor cannot charge you for covered health care services, except for required co-payments. Request a second opinion about a medical condition. Receive emergency care whenever and wherever you need it. See plan Providers, get covered services, and get your prescription filled timely. Receive information about clinical programs, including staff qualifications, request a change of treatment choices, participate in decisions about your health care, and be informed of health care issues that require self-management. If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. If you are under a Doctor’s care for an acute condition, serious chronic condition, pregnancy, terminal illness, newborn care, or a scheduled surgery, you may ask to continue seeing your current Doctor. To make this request, or if you have any concerns about your continuity of care, please call IEHP DualChoice Member Services at 1-877-273-IEHP (4347). Receive Member informing materials in alternative formats, including Braille, large print, and audio. Information on procedures for obtaining prior authorization of services, Quality Assurance, disenrollment, and other procedures affecting IEHP DualChoice Members. IEHP DualChoice will honor authorizations for services already approved for you. If you have any authorizations pending approval, if you are in them idle of treatment, or if specialty care has been scheduled for you by your current Doctor, contact IEHP to help you coordinate your care during this transition time. 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. Review, request changes to, and receive a copy of your medical records in a timely fashion. Receive interpreter services at no cost. Notify IEHP if your language needs are not met. Make recommendations about IEHP DualChoice Members’ rights and responsibilities policies. Be informed regarding Advance Directives, Living Wills, and Power of Attorney, and to receive information regarding changes related to existing laws. Decide in advance how you want to be cared for in case you have a life-threatening illness or injury. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation Complain about IEHP DualChoice, its Providers, or your care. IEHP DualChoice will help you with the process. You have the right to choose someone to represent you during your appeal or grievance process and for your grievances and appeals to be reviewed as quickly as possible and be told how long it will take. Have grievances heard and resolved in accordance with Medicare guidelines; Request quality of care grievances data from IEHP DualChoice. Appeal any decision IEHP DualChoice makes regarding, but not limited to, a denial, termination, payment, or reduction of services. This includes denial of payment for a service after the service has been rendered (post-service) or denial of service prior to the service being rendered (pre-service). Request fast reconsideration; Request and receive appeal data from IEHP DualChoice; Receive notice when an appeal is forwarded to the Independent Review Entity (IRE); Automatic reconsideration by the IRE when IEHP DualChoice upholds its original adverse determination in whole or in part; Administrative Law Judge (ALJ) hearing if the independent review entity upholds the original adverse determination in whole or in part and the remaining amount in controversy is $100 or more; Request Departmental Appeals Board (DAB) review if the ALJ hearing is unfavorable to the Member in whole or in part; Judicial review of the hearing decision if the ALJ hearing and/or DAB review is unfavorable to the Member in whole or in part and the amount remaining in controversy is $1,000 or more; Make a quality of care complaint under the QIO process; Request QIO review of a determination of noncoverage of inpatient hospital care; Request QIO review of a determination of noncoverage in skilled nursing facilities, home health agencies and comprehensive outpatient rehabilitation facilities; Request a timely copy of your case file, subject to federal and state law regarding confidentiality of patient information; Challenge local and national Medicare coverage determination. As an IEHP DualChoice Member, you have the responsibility to: Review your Member Handbook, and call IEHP DualChoice Member Services if you do not understand something about your coverage and benefits Inform your Doctor about your medical condition, and concerns. Follow the plan of treatment your Doctor feels is necessary Make necessary appointments for routine and sick care, and inform your Doctor when you are unable to make a scheduled appointment. Learn about your health needs and leading a healthy lifestyle. Make every effort to participate in the health care programs IEHP DualChoice offers you. For more information on Member Rights and Responsibilities refer to Chapter 8 of your IEHP DualChoice Member Handbook. Rights and Responsibilities Upon Disenrollment Ending your membership in IEHP DualChoice (HMO D-SNP) may be voluntary (your own choice) or involuntary (not your own choice) You might leave our plan because you have decided that you want to leave. There are also limited situations where you do not choose to leave, but we are required to end your membership.Chapter 10 of your IEHP DualChoice Member Handbook tells you about situations when we must end your membership. When can you end your membership in our plan? Because you get assistance from Medi-Cal, you can end your membership in IEHP DualChoice at any time. Your membership will usually end on the first day of the month after we receive your request to change plans. Your enrollment in your new plan will also begin on this day. How to voluntarily end your membership in our plan? If you would like to switch from our plan to another Medicare Advantage plan simply enroll in the new Medicare Advantage plan. You will be automatically disenrolled from IEHP DualChoice, when your new plan’s coverage begins. If you would like to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan. You must ask to be disenrolled from IEHP DualChoice. There are two ways you can asked to be disenrolled: To disenroll, please call Health Care Options (HCO) at 1-844-580-7272, 8am - 6pm (PST), Monday - Friday. TTY/TDD users should call 1-800-430-7077. For more information visit the DHCS website. By clicking on this link, you will be leaving the IEHP DualChoice website. Or you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Until your membership ends, you are still a member of our plan. If you leave IEHP DualChoice, it may take time before your membership ends and your new Medicare coverage goes into effect. (See Chapter 10 of the IEHP DualChoice Member Handbook for information on when your new coverage begins.) During this time, you must continue to get your medical care and prescription drugs through our plan. You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services. If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins). If you no longer qualify for Medi-Cal or your circumstances have changed that make you no longer eligible for Dual Special Needs Plan, you may continue to get your benefits from IEHP DualChoice for an additional two-month period. This additional time will allow you to correct your eligibility information if you believe that you are still eligible. You will get a letter from us about the change in your eligibility with instructions to correct your eligibility information. To stay a member of IEHP DualChoice, you must qualify again by the last day of the two-month period. If you do not qualify by the end of the two-month period, you’ll de disenrolled by IEHP DualChoice. Involuntarily ending your membership IEHP DualChoice must end your membership in the plan if any of the following happen: If you do not stay continuously enrolled in Medicare Part A and Part B. If you move out of our service area for more than six months.        If you become incarcerated. If you lie about or withhold information about other insurance you have that provides prescription drug coverage. If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. If you let someone else use your membership card to get medical care. To be a Member of IEHP DualChoice, you must keep your eligibility with Medi-Cal and Medicare. If you lose your zero share-of-cost, full scope Medi-Cal, you will be disenrolled from our plan (for your Medicare benefits) the first day of the following month and will be covered by the Original Medicare. The State or Medicare may disenroll you if you are determined no longer eligible to the program. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal. Information on this page is current as of October 01, 2022. H8894_DSNP_23_3241532_M

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