Search Results For : " DIPLOMA IN ENVIRONMENTAL SCIE "

als who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan). IEHP has identified the most vulnerable as the following: Age 21-70 Identified as High and Rising Risk Diagnosed with Cardiovascular Disease AND/OR Diabetes RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services. IEHP will identify the most vulnerable members assigned to IPAs IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals. Examples of Specially Tailored Services for the Most Vulnerable Population Remote Patient Monitoring Medically Tailored Meals and Other Community Supports Nutrition Education Pharmacy Services (medication reconciliation and other programs) Long-Term Services and Supports (LTSS) Telehealth Behavioral Health Services Transportation More frequent care management contact IEHP DualChoice (HMO D-SNP) Model of Care Training   The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members: Interdisciplinary Care Team (ICT) Fact Sheet (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)   *We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer    You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

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 D-SNP 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 Exit Letter 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 - IEHP Dual Choice (HMO D-SNP) - effective January 2023 (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)      Chinese (PDF)      Vietnamese (PDF) Medicare Form      English (PDF)      Spanish (PDF)      Chinese (PDF)      Vietnamese (PDF) The following IEHP DualChoice (HMO D-SNP) Letters will be effective January 1, 2023:      English (PDF)      Spanish (PDF)      Chinese (PDF)      Vietnamese (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. 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 August 01, 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 August 01, 2022 Notice of Action – Carve Out English Last Updated: 12/29/2022   Spanish Last Updated: 12/29/2022   Chinese Last Updated: 12/29/2022   Vietnamese Last Updated: 12/29/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 2022 Notice of Action - Delay English Last Updated: 12/27/2022   Spanish Last Updated: 12/27/2022   Chinese Last Updated: 12/27/2022   Vietnamese Last Updated: 12/27/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 2022 Notice of Action - Deny English Last Updated: 12/27/2022   Spanish Last Updated: 12/27/2022   Chinese Last Updated: 12/27/2022   Vietnamese Last Updated: 12/27/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 2022 Notice of Action - Modify English Last Updated: 12/28/2022   Spanish Last Updated: 12/28/2022   Chinese Last Updated: 12/28/2022   Vietnamese Last Updated: 12/28/2022   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 2022 Notice of Action - Terminate English Last Updated: 01/06/2023   Spanish Last Updated: 01/06/2023   Chinese Last Updated: 01/06/2023   Vietnamese Last Updated: 01/06/2023   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 2022 Other Health Care Coverage Requesting Provider Letter English Last Updated: 03/17/2021   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated August 01, 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 August 01, 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 August 01, 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 August 01, 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 October 27, 2022 Denial Reason Matrix English Last Updated: 07/03/2018   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 27, 2022 Detailed Notice of Discharge English Last Updated: 12/17/2021   Spanish Last Updated: 12/17/2021   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 Expedited Criteria Not Met English Last Updated: 10/31/2017   Spanish Last Updated: 10/31/2017   Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 27, 2022 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 October 7, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 7, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 7, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 7, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated October 27, 2022 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 October 27, 2022 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 October 27, 2022 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 October 27, 2022 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 October 27, 2022 (Back to top) NEW D-SNP Letter Templates These templates should not be used until the effective date of January 2, 2023. Please continue using the current Medicare DualChoice letter templates currently seen on this webpage for the remainder of 2022. 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. AOR Dismissal Letter English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 AOR Request Letter English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Continuity of Care - Notice of Authorization English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Continuity of Care – Notice of Termination English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Detailed Explanation of Non-Coverage English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Detailed Notice of Discharge English Last Updated: 12/20/2022   Spanish Last Updated:12/20/2022   Chinese Last Updated:12/20/2022   Vietnamese Last Updated:12/20/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Expedited Criteria Not Met English Last Updated: 09/26/2022   Spanish Last Updated: 09/26/2022   Chinese Last Updated: 09/26/2022   Vietnamese Last Updated: 09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Extension Needed for Additional Information English Last Updated: 09/26/2022   Spanish Last Updated: 09/26/2022   Chinese Last Updated: 09/26/2022   Vietnamese Last Updated: 09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Informational Letter to Beneficiary and PCP English Last Updated: 09/26/2022   Spanish Last Updated: 09/26/2022   Chinese Last Updated: 09/26/2022   Vietnamese Last Updated: 09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Notice of Authorization of Services English Last Updated: 09/27/2022   Spanish Last Updated: 09/27/2022   Chinese Last Updated: 09/27/2022   Vietnamese Last Updated: 09/27/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Notice of Dismissal of Coverage Request English Last Updated: 09/26/2022   Spanish Last Updated: 09/26/2022   Chinese Last Updated: 09/26/2022   Vietnamese Last Updated: 09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Notice of Medicare Non-Coverage English Last Updated:09/27/2022   Spanish Last Updated:09/27/2022   Chinese Last Updated:09/27/2022   Vietnamese Last Updated:09/27/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Cancelled Relocation Letter English Last Updated: 09/22/2022   Spanish Last Updated:09/22/2022   Chinese Last Updated:09/22/2022   Vietnamese Last Updated:09/22/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Long-Term Care IPA and PCP Change Letter English Last Updated: 09/26/2022   Spanish Last Updated:09/26/2022   Chinese Last Updated:09/26/2022   Vietnamese Last Updated:09/26/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Coverage Decision Letter Part B - 7 Day Appeal English Last Updated: 10/03/2022   Spanish Last Updated:10/03/2022   Chinese Last Updated:10/03/2022   Vietnamese Last Updated:10/03/2022   *Additional Information for IPAs: Please include the integrated Coverage Decision Letter, the most recent IMR form, application instructions, DMHC’s toll-free telephone number, and an envelope addressed to DMHC. Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Independent Medical Review (IMR) Form - [English] [Spanish] [Chinese] [Vietnamese] Updated January 01, 2023 State Fair Hearing Form - [English] [Spanish] [Chinese] [Vietnamese] Updated September 01, 2021 Coverage Decision Letter Medical – 30 Day Appeal English Last Updated: 10/03/2022   Spanish Last Updated:10/03/2022   Chinese Last Updated:10/03/2022   Vietnamese Last Updated:10/03/2022   *Additional Information for IPAs: Please include the integrated Coverage Decision Letter, the most recent IMR form, application instructions, DMHC’s toll-free telephone number, and an envelope addressed to DMHC. Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022 Independent Medical Review (IMR) Form - [English] [Spanish] [Chinese] [Vietnamese] Updated January 01, 2023 State Fair Hearing Form - [English] [Spanish] [Chinese] [Vietnamese] Updated September 01, 2021 Coverage Decision Letter - Claims English Last Updated: 11/22/2022   Spanish Last Updated:11/22/2022   Chinese Last Updated:11/22/2022   Vietnamese Last Updated:11/22/2022   Multi-Language Insert - [All Languages] Updated July 26, 2022 Nondiscrimination Notice & Taglines - [English] [Spanish] [Chinese] [Vietnamese] Updated September 07, 2022   (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 (CMC) - English (PDF) Health Risk Assessment (HRA) - IEHP DualChoice  (CMC)- Spanish (PDF) Health Risk Assessment (HRA) - IEHP DualChoice (HMO D-SNP) - English (PDF) - effective 1/1/2023 Health Risk Assessment (HRA) - IEHP DualChoice (HMO D-SNP) - Spanish (PDF) - effective 1/1/2023 Health Risk Assessment (HRA) - IEHP DualChoice (HMO D-SNP) - Chinese (PDF) - effective 1/1/2023 Health Risk Assessment (HRA) - IEHP DualChoice (HMO D-SNP) - Vietnamese (PDF) - effective 1/1/2023 HIV Testing Sites - Riverside and San Bernardino (PDF) Home Health Check Off List (PDF) Home Modification Consent Form (PDF) Long Term Care (LTC) Data Sheet (PDF) Non-Emergency Medical Transportation (NEMT) Physician Certification Statement (PCS) (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) The following IEHP DualChoice (HMO D-SNP) Letters will be effective January 1, 2023: IEHP DualChoice (HMO D-SNP) Non-Covered Services/Materials Waiver Form-English (PDF) IEHP DualChoice (HMO D-SNP) Non-Covered Services/Materials Waiver Form-Spanish (PDF) IEHP DualChoice (HMO D-SNP) Non-Covered Services/Materials Waiver Form-Chinese (PDF) IEHP DualChoice (HMO D-SNP) 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.

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

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) Formulary Change (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

most appropriate, high quality and cost-effective drug therapies.   The Inland Empire Health Plan Pharmacy and Therapeutics (P & T) Subcommittee develops and monitors the Formulary. The P & T is composed of the IEHP Chief Medical Officer, Medical Directors, Director of Pharmaceutical Services, physicians from various medical specialties, local communities, and clinical pharmacists. This panel reviews the medications in all therapeutic categories based on safety, clinical efficacy, and cost-effectiveness and selects the most appropriate drugs in each class.   Formulary development and maintenance is a dynamic process. The IEHP P & T Subcommittee is responsible for developing, managing, updating and administering the Formulary. The Subcommittee also ensures that the IEHP Formulary remains responsive to the needs of our members and providers.   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.   IEHP Medi-Cal Formulary Items: DHCS Noncapitated Physician Administered Drugs (PADs) Medi-Cal Medical Benefit PA (PDF) Medi-Cal Medical Benefit Formulary (PDF) Referral Form for Medi-Cal Benefit (PDF) Exceptions to criteria or requests for coverage of drugs not on the Medi-Cal Drug Benefit Formulary may be submitted by prescribers on the Referral Form for Medi-Cal Benefit. Starting January 1, 2022, all IEHP Medi-Cal pharmacy services will be transitioned from managed care (MC) to fee for service (FFS). The Medi-Cal pharmacy benefits and services administered by the Department of Health Care Services (DHCS) will be identified collectively as "Medi-Cal Rx." Magellan Medicaid Administration, Inc. (MMA) will assume operations for Medi-Cal Rx on behalf of DHCS. For further information on Medi-Cal Rx, please visit: https://www.iehp.org/en/providers/pharmacy-services?target=medi-cal-rx For more information on the Medi-Cal Rx Covered Drug List (CDL), please visit: https://medi-calrx.dhcs.ca.gov/home/cdl   IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan Items: IEHP DualChoice (HMO D-SNP) Formulary Book (PDF) Grievance Coverage Determination and Appeals Process IEHP DualChoice (HMO D-SNP) Formulary Search Tool        10 Reasons Why You Should Be E-prescribing Brochure (PDF) E-prescribing Tips (PDF)   Information on this page is current as of February 02, 2023

Provider Manual - Medi-Cal Provider Manual - IEHP DualChoice (HMO D-SNP) Summary of Effected Changes - Medi-Cal Summary of Effected Changes - IEHP DualChoice (HMO D-SNP) Benefit Manuals EDI Manual Regulatory Trainings 2023 Acknowledgement of Receipt Provider Manuals The Inland Empire Health Plan (IEHP) Provider Policy and Procedure is designed to help IEHP's Contracted Entities (Providers) understand how IEHP works 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), California Managed Risk Medical Insurance Board (MRMIB) and the Centers for Medicare and Medicaid Services (CMS). The provisions of these Provider Manuals must be adhered by all of IEHP's Providers. Provider Manual - Medi-Cal 00 - Table of Contents and Introduction (PDF) 01 - Organizational Structure (PDF) 02 - Committee Overview (PDF) 03 - Enrollment and Assignment (PDF)  04 - Eligibility and Verification (PDF) 05 - Credentialing and Recredentialing (PDF)  06 - Facility Site Review (PDF) 07 - Medical Records Requirements (PDF) 08 - Infection Control (PDF) 09 - Access Standards (PDF)  10 - Medical Care Standards (PDF) 11 - Pharmacy (PDF)  12 - Coordination of Care (PDF) 13 - Quality Management (PDF) 14 - Utilization Management (PDF)  15 - Health Education (PDF) 16 - Grievance and Appeals Resolution System (PDF) 17 - Member Transfers and Disenrollment (PDF) 18 - Provider Network (PDF)  19 - Finance and Reimbursement (PDF) 20 - Claims Processing (PDF) 21 - Encounter Data Reporting (PDF)  22 - Rights and Responsibilities (PDF) 23 - Compliance (PDF) 24 - Program Descriptions (PDF)  25 - Delegation and Oversight (PDF)  26 - Quick Reference (PDF)  Summary of Effected Changes (PDF) - Published: September 30, 2022 (Back to top) Provider Manual - IEHP DualChoice (HMO D-SNP) 00 - Table of Contents and Introduction (PDF)  01 - Organizational Structure (PDF) 02 - Committee Overview (PDF)  03 - Enrollment and Assignment (PDF)  04 - Eligibility and Verification (PDF) 05 - Credentialing and Recredentialing (PDF) 06 - Facility Site Review (PDF) 07 - Medical Records Requirements (PDF) 08 - Infection Control (PDF) 09 - Access Standards (PDF)  10 - Medical Care Standards (PDF) 11 - Pharmacy (PDF) 12 - Coordination of Care (PDF)  13 - Quality Management (PDF)  14 - Utilization Management (PDF)  15 - Health Education (PDF) 16 - Grievance and Appeals Resolution System (PDF) 17 - Member Transfers and Disenrollment (PDF) 18 - Provider Network (PDF)  19 - Finance and Reimbursement (PDF) 20 - Claims Processing (PDF) 21 - Encounter Data Reporting (PDF)  22 - Rights and Responsibilities (PDF) 23 - Compliance (PDF) 24 - Program Descriptions (PDF)  25 - Delegation and Oversight (PDF)  26 - Quick Reference (PDF)  Summary of Effected Changes (PDF) - Published: September 30, 2022 (Back to top) Benefits These Benefit Manuals are offered as guidelines to determine benefit eligibility and are not intended to be construed as or to serve as a standard of medical care, or as a contractual agreement for payment. Standards of medical care are determined on the basis of all facts and circumstances for each individual case. Benefit Manual Information The subheadings “Examples of Covered Benefits” and “Examples of Non-Covered Benefits” are meant to give specific examples but are not intended to be an all-inclusive list of examples, unless specified in the text of the benefit. 2023 Medi-Cal 2023 IEHP DualChoice (HMO D-SNP) and Plan Benefits and Cost Sharing  If a benefit question is not addressed in the Benefit Manual, please contact IEHP at (909) 890-2000 for further information. (Back to top) Electronic Data Interchange (EDI) The manual documents the procedures, protocols and formats for electronic data exchange between IEHP and its contracted Providers related to Member eligibility, encounter data, bed-day reporting, capitation reports and electronic claims submissions. The following sections document the processing schedules, file formats, procedures and narrative information that is necessary for Providers to understand and conduct electronic data exchange that is HIPAA compliant which is required under the IEHP Agreement. EDI Manual 00 - Table of Contents (PDF) 01 - General Information (PDF) 02 - Getting Started (PDF) 03 - Eligibility Processing Procedures (PDF) 04 - Encounter Data Processing Procedures (PDF) 05 - Capitation Processing Procedures (PDF) 06 - Claims EDI Processing Procedures (PDF) 07 - Timeframe and Schedules (PDF)  08 - IEHP 5010 837I Institutional IEHP DualChoice Encounter Companion Guide (PDF)  09 - IEHP 5010 837I Institutional Medi-Cal Encounter Companion Guide (PDF) 10 - IEHP 5010 837P Professional IEHP DualChoice Encounter Companion Guide (PDF)  11 - IEHP 5010 837P Professional Medi-Cal Encounter Companion Guide (PDF) 12 - IEHP 5010 837I Institutional Claims Companion Guide (PDF) 13 - IEHP 5010 837P Professional Claims Companion Guide (PDF) 14 - Authorization Data Exchange (PDF) 15 - IEHP 5010 834 Standard Companion Guide (PDF)  16 - IEHP 835 Standard Companion Guide (PDF) 17 - IEHP Misdirected Outbound Professional Claims Companion Guide (PDF) 18 - IEHP Misdirected Outbound Institutional Claims Companion Guide (PDF)  For comments, questions about this manual or technical support, contact the IEHP IT Help Desk at (909) 890-2025 or by email at: HELPDESK@iehp.org. (Back to top) Regulatory Trainings Code of Business Conduct and Ethics (PDF) Compliance Training (FWA, HIPAA Privacy and Security) (PDF) Cultural and Linguistics (C & L) Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML) (Back to top) 2023 Acknowledgement of Receipt Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox How-To Guide for Provider eAOR (PDF) FAQs for Provider eAOR (PDF) Provider AOR (PDF) Hospital AOR (PDF) Delegate AOR (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.

here. TITLE DATE RECIPIENTS February 2023     UPDATE – Initial Health Appointment and Retirement of IHEBA/SHA 02/02 All Medi-Cal PCPs & IPAs Transition to 30-day Coverage Determination Backdating 02/02 All LTC & SNF Providers Redlands Community Hospital – Behavioral Health Unit Closed 02/01 All PCPs & BH Providers UPDATE - Independent Medical Review Form 02/01 All Medicare IPAs January 2023     KidsVaxGrant 3.0 Deadline to Apply is February 17, 2023 01/31 All Pediatricians and Family Practice PCPs Effective February 1, 2023 - Call The Car Will Replace American Logistics Company (ACL) for ALL Member Transportation 01/31 All PCPs, Specialists, BH & IPAs Provider Manual Acknowledgement of Receipt (AOR) Winners 01/27 All Providers Crisis Recovery Resource Guide and Toolkit Available 01/27 All Community Support Services REMINDER - BHT Providers Must Submit Exit Reports and Exit Letters! 01/27 All BHT (QASP) Providers D-SNP Model of Care Incentive Program - 2023 Program Guide Release 01/26 All Medicare IPAs Help Protect Members - Flu Vaccine Reminder 01/25 All PCPs 2023 Global Quality P4P PCP Kick Off Meeting 01/25 All Medi-Cal PCPs 2023 Global Quality P4P IPA Kick Off Meeting 01/25 All IPAs An ECHO Learning Opportunity - Alzheimer's And Dementia Care - Weekly Sessions Begin Feb 16th 01/24 All PCPs REMINDER - 2023 Global Quality P4P Program - CAIR2 Participation Requirement- PCPs 01/23 All Medi-Cal PCPs REMINDER - 2023 Global Quality P4P Program - CAIR2 Participation Requirement- IPAs 01/23 All Medi-Cal IPAs Response Requested by Thursday, January 26! - CBAS Emergency Remote Services (ERS) 01/23 All CBAS Providers Global Quality P4P PCP Program - 2023 Program Guide Release 01/19 All Medi-Cal PCPs UPDATE! Medi-Cal Letter Templates 01/17 All Medi-Cal IPAs Emergency Resource Guide and Services – Flooding Services Available! 01/17 All Community Support Services Providers Medicare P4P IEHP Direct – Blood Pressure Control Billing Guidance 01/13 All DualChoice PCPs NEW! Regulatory Submission Response Files – MAO-004 XWalk 01/13 All Medicare IPAs ALERT! 837 SBR04 Encounter Data Requirement Changes 01/13 All Medicare IPAs IEHP DualChoice (D-SNP) Model of Care Training Requirement 01/12 All DualChoice Hospitals IEHP DualChoice (D-SNP) Model of Care Training Requirement 01/10 All Medicare IPAs IEHP DualChoice (D-SNP) Model of Care Training Requirement 01/10 All DualChoice Providers IEHP Outbound 834 File Update 01/10 All 834 Trading Partners IEHP HOLIDAY - Martin Luther King Jr. Day 01/09 All IEHP Providers CORRECTION to Changes to Quarterly Workplan Requirements 01/05 All Medicare IPAs LAST CHANCE to Win a $50 Gift Card - Submit 2023 Provider Policy and Provider Manual Acknowledgement of Receipt (AOR) 01/04 All IEHP Providers 2023 Population Health Management Academy 01/04 All Riverside County PCPs CORRECTION - 2022 GQ P4P PCP - Quality Bonus Services Code Update 01/03 All Medi-Cal PCPs December 2022     Outbound Eligibility File Delay on January 1, 2023 12/29 All IPAs and Ancillary Providers REMINDER - CoverMyMeds - Prior Authorization Submission Method for Dual Choice Members– Effective January 1, 2023 12/29 All Dual Choice PCPs & Specialists REMINDER - Pharmacy Benefits Manager (PBM) Change for DualChoice (HMO D-SNP) - Member Outreach in Process 12/29 All Dual Choice PCPS and Medicare IPAs Access Standards – Appointment Availability - BH Providers 12/28 All Behavioral Health Providers Mandatory Managed Care Enrollment (MMCE) Phase II - January 1, 2023 12/27 All Medi-Cal PCPs & Specialists Access Standards – Appointment Availability - PCPs & OB/GYNs 12/27 All PCPs & OB/GYNs Access Standards – Appointment Availability - Specialists 12/27 All Specialists NEW! State Fair Hearing and Independent Medical Review Forms added to D-SNP Letter Templates (Effective January 2, 2023) 12/27 All Medicare IPAs REMINDER - Help Your Members Update Their Contact Information! 12/22 All PCPs 2022 GQ P4P PCP - Quality Bonus Services Code Update 12/22 All Medi-Cal PCPs & IPAs UPDATED! D-SNP Letter Templates (Effective January 2, 2023) 12/21 All Medicare IPAs Phase II Wave I– Prior Authorization Submission – January 20, 2023 12/21 Medi-Cal PCPs & Specialists Crossing the Line - Examining Professional, Personal, & Ethical Boundaries 12/21 Riverside County PCPs & Specialists IEHP Outbound Daily 834 Delta File Delay 12/20 All 834 Trading Partners Revised UM Authorization Guidelines 12/19 All IPA Administrators & Medical Directors REMINDER - IEHP DualChoice (HMO D-SNP) begins Jan 2023 12/19 All Medicare PCPs, Specialists & BH Providers OB P4P Program - Early Postpartum Visit Update 12/19 All Medi-Cal OB/GYNs My Life. My Choice. - An Online Advanced Care Planning Program 12/16 All Dual Choice PCPs REMINDER - CoverMyMeds - Prior Authorization Submission Method for Dual Choice Members– Effective January 1, 2023 12/16 All Dual Choice PCPs & Specialists IEHP 2022-2023 Holiday Hours 12/15 All Providers & IPAs 2022 Global Quality P4P Program – Data Submission Deadlines for PCPs! 12/15 All Medi-Cal PCPs 2022 Global Quality P4P Program – Data Submission Deadlines for IPAs! 12/15 All Medi-Cal IPAs CORRECTION– New Fax Number for Physician Certification Statements for Non-Emergency Medical Transportation 12/09 All Hospitals and SNFs Medicare Formulary Changes for 2023 IEHP DualChoice (HMO D-SNP) 12/08 All Medicare PCPs, Specialists & IPAs Pharmacy Recalls, Withdrawals & Safety Alerts - November 2022 12/07 All PCPs REMINDER - Physician Certification Statement (PCS) Requirement 12/06 All PCPs, Specialists, BH & IPAs EVV Home Health Care Services Open Office Hours – December 16th 12/06 EVV Impacted Providers & Individual Nurse Practitioners Mpox (formerly Monkeypox) Vaccine Available through Local Health Departments 12/05 All Medi-Cal PCPs & IPAs IMPORTANT! DHCS Error – Members Will NOT be Disenrolled From IEHP 12/05 All Medicare PCPs & IPAs Global Quality P4P PCP – 2022 Program Guide Update (Quality Bonus Services) 12/05 All Medi-Cal PCPs The Alzheimer's Association Event - Resources for Improving Dementia Care in the Clinical Practice 12/02 All PCPs CoverMyMeds - Prior Authorization Submission Method for Dual Choice Members– Effective January 1, 2023 12/02 All Dual Choice PCPs REMINDER - IEHP Dual Choice (HMO D-SNP) begins Jan 2023 12/02 All Medicare PCPs, Specialists & BH Providers Response Requested by December 6, 2022! - CBAS Emergency Remote Services - Reporting 12/02 All CBAS Providers IEHP Formulary Changes - November P&T Update 12/02 All PCPs November 2022 Pharmacy and Therapeutics Subcommittee Update 12/02 All PCPs NEW! D-SNP Letter Templates - Claims (Effective January 2, 2023) 12/02 All Medicare IPAs COVID-19 Isolation in SNF 12/01 All SNFs Living the Mission Awards Nomination Form 12/01 All IEHP Providers November 2022     Inland Empire Community Health Assessment 11/30 All PCPs, IPAs, Specialists, & Behavioral Health Providers Pharmacy Benefits Manager (PBM) Change for DualChoice (HMO D-SNP) - Member Outreach in Process 11/29 All DualChoice PCPs & Medicare IPAs ID Cards with Errors Reissued to Dual Choice Members 11/23 Select Dual Choice PCPs Inland Caregiver Resource Center Informational Webinar - ECHO 11/23 All PCPs IEHP’s Quarterly Behavioral Health Provider Training 11/18 All Behavioral Health (BH) Providers Thanksgiving Holiday 11/18 All IEHP Providers IEHP Outbound Daily 834 Delta File Delay 11/18 All 834 Trading Partners CoverMyMeds - Prior Authorization Submission Method for Dual Choice Members– Effective January 1, 2023 11/17 All IEHP DualChoice PCPs IEHP DualChoice (HMO D-SNP) 2023 Vision Benefits 11/17 All Vision Providers Riverside County Medical Association's Physician Holiday Social 11/17 All Riverside County PCPs & Specialists RUHS - PHA - Early Respiratory Syncytial Virus (RSV) and Seasonal Influenza Activity 11/17 All Riverside County PCPs Global Quality P4P PCP Meeting - 2023 Program Preview 11/16 All Medi-Cal PCPs BHT (QASP) Provider Training 11/15 All BHT (QASP) Providers Reminder - BH Emergency Instruction Standards 11/15 All BH Providers Reminder - PCP and Specialist Emergency Instruction Standards 11/15 All PCPs & Specialists UPDATE! D-SNP Letter Templates (Effective January 2, 2023) 11/15 All Medicare IPAs UPDATE - Revised UM Authorization Guidelines to November 3, 2022 - UM-BH 08 11/14 All Medi-Cal IPAs & BHT Providers Pharmacy Recalls, Withdrawals & Safety Alerts - October 2022 11/14 All PCPs REMINDER: IEHP DualChoice (HMO D-SNP) begins Jan 2023 11/10 All Medicare PCPs, Specialists & BH Providers REMINDER: Help Your Members Update Their Contact Information! 11/10 All IEHP PCPs Maternal Wellness Event Flyer 11/09 All Medi-Cal PCPs, OB/GYNs, Peds, BH Providers & IPAs Essure System - No Longer a Covered Benefit 11/09 All OB/GYNs ACTION REQUIRED -Submit 2023 Provider Policy and Provider Manual Acknowledgement of Receipt (AOR) - Win a $50 Gift Card 11/08 All IEHP Providers Veterans Day 11/04 All IEHP Providers & IPAs Revised UM Authorization Guidelines 11/03 All BH Providers & IPAs Pharmacy Recalls, Withdrawals & Safety Alerts - September 2022 11/02 All PCPs October 2022     Medicare - Nondiscrimination Notice and Taglines Templates 10/31 All Medicare IPAs REMINDER: IEHP Interpreter Services – A Covered Benefit! 10/31 All PCPs & IPAs Continuous Glucose Monitors 10/28 All Medicare PCPs, Endocrinologists & IPAs Health Education Classes Available in Riverside Area 10/27 All Riverside Area PCPs, Specialists & OBs PHA - Outbreak of Ebola Virus Disease Due to Sudan Virus in Central Uganda 10/25 All Riverside County PCPs 834 Eligibility File Format Changes 10/25 All IHEP 834 Trading Partners Global Quality P4P IPA Meeting – 2023 Program Preview 10/21 All Medi-Cal IPAs REMINDER DHCS Hospice Rates – Prospective Calculation Based on Medicaid Rates 10/21 All Hospice Providers NEW! D-SNP Letter Templates (Effective January 2, 2023) 10/21 All Medicare IPAs Help Protect Your Members Against the Flu 10/20 All PCPs & IPAs Public Health Emergency (PHE) Ending Soon – Help Your Members Reenroll! 10/19 All IEHP PCPs REMINDER - Balance Billing of IEHP Members Not Permitted! 10/14 All IEHP Providers ACTION REQUIRED - Correct Prioritization of Authorization Requests 10/14 All PCPs, Specialists & IPAs Global Quality P4P PCP Meeting – 2023 Program Preview 10/13 All Medi-Cal PCPs Flu Vaccine Notice -Access to Pharmacy Vaccine Network 10/13 All PCPs  Cal MediConnect Sunsets and IEHP Dual Choice (D-SNP) Begins 10/12 All PCPs Academic Detailing Services Now Offered 10/11 All IEHP Providers & Pharmacies REMINDER - ACTION REQUIRED - Electronic Visit Verification (EVV) Implementation Requirements – Self Registration Required by October 19, 2022 10/10 All Home Health Care Services (HHCS) Providers & Personal Care Services (PCS) UPDATE - Independent Medical Review (IMR) Forms 10/10 All Medicare IPAs UPDATE to September 8, 2022 Communication Authorization Timeframes 10/6 All Medi-Cal IPAs Special Fraud Alert - Exercise Caution with Purported Telemedicine Companies 10/6 All IEHP Providers & IPAs FAQs For Delegate Monitoring of Utilization Measures 10/5 All IPAs 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  Recalls, Withdrawals & Safety 09/08 All IEHP Providers & Pharmacies 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 P&T Update 09/02 All IEHP Providers & Pharmacies August 2022     2022 - 2023 Flu Vaccination for IEHP Members  08/31 All IEHP Providers & Pharmacies 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 Medication Reconciliation Program 08/29 All IEHP Providers & Pharmacies 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 Medication Reconciliation Program 08/22 All IEHP Providers & Pharmacies 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 Medication Reconciliation Program 08/15 All IEHP Providers & Pharmacies 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 Recalls, Withdrawals & Safety 08/10 All IEHP Providers & Pharmacies 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 Medication Reconciliation Program 08/01 All IEHP Providers & Pharmacies 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 Recalls, Withdrawals & Safety 07/07 All IEHP Providers & Pharmacies 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 May 2022 P&T Update 06/22 All IEHP Providers & Pharmacies 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 MTM Medi-Cal Provider Mailing Campaign 06/08 All IEHP Providers & Pharmacies MTM Medicare Provider Mailing Campaign 06/08 All IEHP Providers & Pharmacies  Recalls, Withdrawals & Safety 06/05 All IEHP Providers & Pharmacies  Academic Detailing Services Now Offered 06/04 All IEHP Providers & Pharmacies 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  Recalls, Withdrawals & Safety Alerts 05/05 All IEHP Providers & Pharmacies Providers 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 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 Important Notice: Proton Pump Inhibitor Overutilization 04/05 All IEHP Providers & Pharmacies Recalls, Withdrawals & Safety Alerts 04/05 All IEHP Providers & Pharmacies 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 MTM Medi-Cal Provider Mailing Campaign 03/29 All IEHP Providers & Pharmacies MTM Medicare Provider Mailing Campaign 03/29 All IEHP Providers & Pharmacies 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 New DHCS DUR Board Educational Article 03/16 All IEHP Providers & Pharmacies 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 Recalls, Withdrawals & Safety Alerts 03/07 All IEHP Providers & Pharmacies 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 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

ities of Canyon Lake, Corona, Eastvale, Jurupa Valley, Lake Elsinore, and Norco, along with the unincorporated communities of Coronita, El Cerrito, Gavilan Hills, Home Gardens, Lake Mathews, Lakeland Village, Temescal Valley, Warm Springs, Woodcrest. She was appointed to the IEHP Governing Board in February 2019, became vice chair in January 2020 and chair in 2021. Supervisor Spiegel began her political career as the elected city treasurer for the city of Corona in 1996. She continued her service in Corona as a council member for 16 years and as mayor for four terms.  

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 February 2023     Transition to 30-day Coverage Determination Backdating 02/02 All LTC & SNF Providers January 2023     IEHP DualChoice (HMO D-SNP): Over-the-Counter Drugs 01/09-01/30 All IEHP Pharmacy Providers IEHP DualChoice (HMO D-SNP): Medicare Part B Coinsurance Billing 01/05-01/13 All IEHP Pharmacy Providers IEHP DualChoice (HMO D-SNP): PBM Update and Medicare Part B Coinsurance 01/02-01/20 All IEHP Pharmacy Providers IEHP DualChoice (HMO D-SNP) Members - Medication Overrides 01/02 All IEHP Pharmacy Providers December 2022     Cal MediConnect (CMC) to Medi-Cal Rx/HMO D-SNP Transition 12/22 All IEHP Pharmacy Providers Claims Rejected in Error 12/19 All IEHP Pharmacy Providers PBM Change & Prior Authorization Submission Method - for DualChoice (HMO D-SNP) Members (Effective January 1, 2023) 12/13-12/29 All IEHP Pharmacy Providers Pharmacy Recalls, Withdrawals & Safety Alerts - November 2022 12/07 All IEHP Pharmacy Providers CoverMyMeds - Prior Authorization Submission Method for DualChoice Members (Effective January 1, 2023) 12/01-12/12 All IEHP Pharmacy Providers November 2022     Recalls, Withdrawals & Safety Alerts - October 2022 11/14 All IEHP Pharmacy Providers Recalls, Withdrawals & Safety Alerts - September 2022 11/02 All IEHP Pharmacy Providers COVID-19: Test to Treat Monoclonal Antibodies 11/01 All IEHP Pharmacy Providers October 2022     Cal MediConnect to Medi-Cal Rx Transition (D-SNP) 10/28 All IEHP Pharmacy Providers 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  

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

g. Click here to register for this in-person class Location IEHP Community Resource Center (Victorville) 12353 Mariposa Rd Suites C-2 & C-3 Victorville, CA 92395    

is necessary for some people and how different types of medicines help manage diabetes. Click here to register for this in-person class Location IEHP Community Resource Center (Riverside) 3590 Tyler St Riverside, CA 92503

ise impacts blood sugar, different types of exercise, and addressing barriers to exercise.  Click here to register for this in-person class Location IEHP Community Resource Center (Riverside) 3590 Tyler St Riverside, CA 92503

earn about different types of physical activities to improve heart health as well as learn how to control your blood pressure.  Click here to register for this in-person class Location IEHP Community Resource Center (Victorville) 12353 Mariposa Rd Suites C-2 & C-3 Victorville, CA 92395    

pic: Healthy Communication – Learn how to communicate your needs clearly to your doctor or your support network. Click here to register for this in-person class Location IEHP Community Resource Center (Victorville) 12353 Mariposa Rd Suites C-2 & C-3 Victorville, CA 92395

e is necessary for some people and how different types of medicines help manage diabetes. Click here to register for this in-person class Location IEHP Community Resource Center (San Bernardino) 805 W 2nd St San Bernardino, CA 92410

Topic: Healthy Communication – Learn how to communicate your needs clearly to your doctor or your support network. Click here to register for this in-person class Location IEHP Community Resource Center (San Bernardino) 805 W 2nd St San Bernardino, CA 92410

Topic: Staying on Course: You will learn how to get past frustration even when you feel stuck. Click here to register for this in-person class Location IEHP Community Resource Center (San Bernardino) 805 W 2nd St San Bernardino, CA 92410

learn about different types of physical activities to improve heart health as well as learn how to control your blood pressure.  Click here to register for this in-person class Location IEHP Community Resource Center (San Bernardino) 805 W 2nd St San Bernardino, CA 92410

happens in the lungs when asthma symptoms start, learn about asthma triggers, and how to avoid asthma attacks. Click here to register for this in-person class Location IEHP Community Resource Center (San Bernardino) 805 W 2nd St San Bernardino, CA 92410