Search Results For : " DIPLOMA IN ENVIRONMENTAL SCIE "
Provider Resources - IEHP DualChoice - Model of Care
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.
Provider Resources - Forms
liance
Delegation Oversight Audit (DOA)
Grievance
Growth Chart
Health and Wellness
Historical Data Form
Inland Regional Center
Medi-Cal Letter Templates
Medicare-Medicaid Plan Letter Templates
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)
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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)
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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
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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)
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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)
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Health and Wellness
DPP Rx Pad (PDF)
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Historical Data Form
Historical Data Form (PDF)
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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
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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
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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
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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
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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)
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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.
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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)
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Pharmacy
Click here for Pharmacy forms.
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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
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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
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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)
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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)
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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)
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You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Member Advisory Committee - Persons with Disabilities Workgroup
uide our services. As a result, we are able to improve how we deliver care and services. If you are an IEHP Member with a disability, you can request to be a Member of our PDW.
The PDW meets every three months at IEHP. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss any communication needs and access issues that Members may have.
To apply for membership in this workgroup, please call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.
2023 Meeting Schedule
February 8, 2023
May 10, 2023
August 9, 2023
November 8, 2023
Time: 12pm - 2pm
IEHP DualChoice - Prescription Drugs
CMS requirements for pharmacy access in your area. There are over 700 pharmacies in the IEHP DualChoice network. IEHP DualChoice network providers are required to comply with minimum standards for pharmacy practices as established by the State of California.
What Prescription Drugs Does IEHP DualChoice Cover?
IEHP DualChoice (HMO D-SNP) has a list of Covered Drugs called a Formulary. It tells which Part D prescription drugs are covered by IEHP DualChoice. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The list must meet requirements set by Medicare. Medicare has approved the IEHP DualChoice Formulary.
Find a covered drug below:
2023 Formulary (PDF)
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
Pharmacy Services - Formulary
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 Manuals - 2023 Manuals
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
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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
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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.
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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.
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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)
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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)
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You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Plan Updates - Correspondence
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.
Governing Board - Karen Spiegel
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.
Pharmacy Communications - Pharmacy Communications
or later to view the PDF files. You can download a free copy by clicking here. By clicking on this link, you will be leaving the IEHP website.
TITLE
DATE
RECIPIENTS
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
Community Resource Centers - About Us
HP Community Resource Centers (CRC) are your local resource for healthcare information in Riverside, San Bernardino and Victorville. Our friendly, bilingual staff can help you take free classes, learn about health care, and about health coverage programs. Our doors are open to IEHP Members and the community.
We Have In-Person and Online Classes
Fitness Classes
Stay active with classes like Yoga, Zumba (all levels), Tai Chi, Line Dance, Yoga for Seniors & People with Disabilities, Meditation, Aerobic Box, Latin Dance, Strength and Conditioning, and Kid Aerobics.
Wellness Classes
Learn about nutrition, managing asthma symptoms, controlling diabetes, stress management, breathing and relaxation.
Where can I find Classes?
In Person: Riverside | San Bernardino | Victorville
Online: Virtual Classes
Riverside Community Resource Center
VIEW OUR MONTHLY RIVERSIDE CRC CALENDAR
Click to Download PDF
Click Para Descargar PDF
Riverside CRC Address:
3590 Tyler Street, Suite 101, Riverside, CA 92503
Riverside CRC Phone:
1-866-228-4347
TTY users should call 711
View Our Other CRC Locations:
San Bernardino CRC
Victorville CRC
Virtual/Online
Click to view in Google Maps
San Bernardino Community Resource Center
VIEW OUR MONTHLY SAN BERNARDINO CRC CALENDAR
Click to Download PDF
Click Para Descargar PDF
San Bernardino CRC Address:
805 West 2nd Street, Suite C, San Bernardino, CA 92410
San Bernardino CRC Phone:
1-866-228-4347
TTY users should call 711
View Our Other CRC Locations:
Riverside CRC
Victorville CRC
Virtual/Online
Click to view in Google Maps
Victorville Community Resource Center
VIEW OUR MONTHLY VICTORVILLE CRC CALENDAR
Click to Download PDF
Click Para Descargar PDF
Victorville CRC Address:
12353 Mariposa Road, Suites C-2 & C-3, Victorville, CA 92395
Victorville CRC Phone:
1-866-228-4347
TTY users should call 711
View Our Other CRC Locations:
Riverside CRC
San Bernardino CRC
Virtual/Online
Click to view in Google Maps
Visit our on-site partner agencies for the following services:
Goodwill Southern California: A workforce provider helping individuals empower themselves with the skills and job support services they need and want to thrive.
Housing Authority of the County of San Bernardino: Affordable housing provider and rental assistance to low-income families via vouchers or affordable housing units.
Young Visionaires Youth Leadership Academy: Mentorship enriching lives of young people through life building activities and instruction in the areas of education, employment, health, mentoring, and community service.
Community Action Partnership of San Bernardino County: Providing Home Energy Assistance Program (HEAP) and Housing Assistance for San Bernardino County residents.
TODEC: Provides legal immigration services, advocacy, community organizing, and civic engagement.
Virtual Classes
VIEW OUR MONTHLY ONLINE CLASSES CALENDAR
Click to Download PDF
Click Para Descargar PDF
Join the Classes via Facebook:
Our Community Resource Centers are now offering virtual classes via Facebook. Join a class today.
Join the Classes via WebEx:
Webex Classes (Password: 12345):
Apple Users
Android Users
PC Users