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ated to help IEHP Members to find high-quality local pharmacies for your pharmacy services. This searchable system will display the rating of each participating pharmacy. The ratings range from 1 to 5 stars (with 1 being the lowest and 5 being the highest). What does the rating scale mean? The rating is on a scale of 1 to 5 stars (with 1 being the lowest and 5 being the highest).    Star Ratings Performance Description 1 Star Well below average 2 Stars Below average 3 Stars Average 4 Stars Good 5 Stars Exceptional No Star No information is available for this pharmacy Please keep in mind that Pharmacy Quality Star Rating is currently under development and may not reflect the most recent ratings of your Pharmacy at this time. IEHP Pharmacy Quality Rating is visible with IEHP "Find a Doctor, Urgent Care, or Pharmacy" webpage (select “Pharmacies” and put in your zip code or city, then hit “Find”). The quality rating information is displayed on the right side of each pharmacy. Information on this page is current as of January 1, 2022      

addresses the clinical and non-clinical needs of high-need, high-cost IEHP Members through systematic coordination of services and comprehensive care management. ECM is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to individuals. It serves to build on the Health Homes Program (HHP) and Whole Person Care (WPC) pilots and transitions those pilots to one larger program to provide a broader platform to build on positive outcomes from each program. ECM provides these vulnerable Members an additional care team to help coordinate and manage their care. The care team consists of a Nurse Care Manager, a Behavioral Health Care Manager, a Care Coordinator, and a Community Health Worker. These specially trained professionals collaborate with IEHP Members' Primary Care Physicians, Specialists, and family support systems to create a personalized plan of care. Beginning January 1, 2022, please direct eligible IEHP Members who need the ECM services to call IEHP Member Services at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347. If you have programmatic questions, please submit them to ECM@iehp.org. IEHP Enhanced Care Management Member Brochure (PDF) CalAIM Enhanced Care Management Policy Guide (PDF)   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

page. What is CCS? CCS is a statewide program that enables children with qualifying conditions to receive specialized services related to that condition independent from IEHP. The CCS program provides diagnostic and treatment services, and medical case management for those who have qualifying conditions. CCS also provides occupational and physical therapy services through the Medical Therapy Program (MTP). The Medical Therapy Program (MTP) is a special program that provides physical therapy (PT), occupational therapy (OT), for children who have disabling conditions, generally due to neurological or musculoskeletal disorders Who Qualifies? The CCS program services children and young adults under the age of 21 who have eligible medical conditions. Examples of CCS-eligible conditions include, but are not limited to, chronic and acute medical conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries, and infectious diseases producing major sequelae. For a more inclusive list of diagnoses and medical criteria of qualifying conditions please reference the below links: https://www.dhcs.ca.gov/services/ccs https://www.dhcs.ca.gov/services/ccs/Documents/CCSMedicalEligibility.pdf Provider Responsibilities Primary Care Physicians (PCPs), Specialty Providers, and IPA/Medical Groups are responsible for performing appropriate baseline health assessments and diagnostic evaluations sufficient to identify children and young adults with potential CCS-qualifying conditions and refer to CCS as needed. PCPs are responsible for all well child and pediatric preventative services as these services are not a covered benefit of CCS. PCPs are also responsible in assisting CCS members with transition from CCS to IEHP authorizations at the age of 21 when members age out of the CCS program. Benefits of CCS Enrollment CCS Clients are not restricted to in area providers but have access to any CCS paneled provider within the state of California when a need for the specialty care has been determined to be CCS eligible. Once a client is determined to be eligible for CCS, the client will continue to be medically eligible for CCS until treatment is complete or age 21 when the CCS program ends. Additional Resources To assist our valued Providers, every Member active with CCS has a distinct red “CCS” widget in the Provider Portal. Opening that widget enables you to view the diagnosis being treated and any Specialists and their treatment authorization range. For any questions about your Member’s CCS care or management, please do not hesitate to contact IEHP’s CCS Team at: (800) 706-4347 or by email at CCSCareManagement@iehp.org . (By clicking on the links below, you will be leaving the IEHP site) For additional CCS resources please reference the below links: CCS Program Overview: https://www.dhcs.ca.gov/services/ccs CCS Program Application: https://www.dhcs.ca.gov/formsandpubs/forms CCS Brochure (English/Spanish): https://www.dhcs.ca.gov/services/ccs/Pages/CCSBrochure.aspx How to become a CCS Provider: https://www.dhcs.ca.gov/services/ccs/Pages/ProviderEnroll.aspx You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

assist primary care providers in delivering care in accordance with IEHP standards. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint. Preventive Care Guidelines American College of Obstetricians and Gynecologists (ACOG) American Academy of Pediatricians (AAP) / Bright Futures Comprehensive Perinatal Services Program (CPSP) Clinical Practice Guidelines Library The guidelines contained on this page are recommended by IEHP with the intent to enhance Member care. IEHP’s Clinical Practice Guidelines topics are organized using the following categories: United States Preventive Services Task Force (USPSTF); IEHP Internal Library; Healthcare Effectiveness Data Information Set (HEDIS); and Managed Care Accountability Set (MCAS) Links or documents embedded within the Internal Library category indicate literature that has been published by leading, formal organizations and have been endorsed/approved by IEHP’s Medical Directors and Quality Committee. IEHP produced information relevant to the topic will also be listed in this category. We have also indicated any HEDIS/ MCAS measures that are pertinent to the topic. Additionally, IEHP accepts USPSTF guidelines to help primary care clinicians identify clinical preventive services that are appropriate for their patients. IF there is a USPSTF guideline relevant to the topic, we have identified it below.  Library Catalog Click on a letter to jump to that specific section: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A Asthma USPSTF N/A IEHP Internal Library Global Strategy for Asthma Management and Prevention (PDF) HEDIS Asthma Medication Ratio (AMR) Medication Management for People with Asthma (MMA) MCAS Asthma Medication Ratio (AMR) (Back to Library Catalog) B Breast Cancer USPSTF Breast Cancer Screening Use of Medications to Prevent Breast Cancer BRCA Testing IEHP Internal Library N/A HEDIS Breast Cancer Screening (BCS) MCAS Breast Cancer Screening (BCS) (Back to Library Catalog) C Cervical Cancer USPSTF Cervical Cancer Screening IEHP Internal Library N/A HEDIS Cervical Cancer Screening (CCS) MCAS Cervical Cancer Screening (CCS) (Back to Library Catalog) Chlamydia USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS Chlamydia Screening in Women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Cholesterol USPSTF Statin Therapy for Primary Prevention of CVD Healthful Diet and Physical Activity for CVD Prevention in Adults with CVD Risks IEHP Internal Library American Heart Association – Blood Cholesterol Management (PDF) American Heart Association – Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (PDF) HEDIS Statin Therapy for Patients with Cardiovascular Disease-Adherence (SPC) Statin Therapy for Patients with Cardiovascular Disease – Statin Therapy (SPC) MCAS N/A (Back to Library Catalog) Chronic Obstructive Pulmonary Disorder USPSTF N/A IEHP Internal Library Global Initiative for Chronic Obstructive Lung Disease – COPD (PDF) HEDIS Pharmacology Management of COPD Exacerbation – Systemic Corticosteroids (PCE) Pharmacology Management of COPD Exacerbations – Bronchodilators (PCE) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) MCAS N/A (Back to Library Catalog) Colorectal Cancer USPSTF Colorectal Cancer Screening IEHP Internal Library N/A HEDIS Colorectal Cancer Screening (COL) MCAS N/A (Back to Library Catalog) D Depression USPSTF Screening for Depression in Adolescents Screening for Depression in Adults including Pregnant Women Screening for Perinatal Depression IEHP Internal Library American Academy of Pediatrics – Adolescent Depression in Primary Care (PDF) American Psychiatric Association – Major Depressive Disorder (PDF) HEDIS Antidepressant Medication Management Acute Phase (AMM) Antidepressant Medication Management Continuation Phase (AMM) MCAS Antidepressant Medication Management Acute (AMM-Acute) Antidepressant Medication Management Continuation (AMM-Cont) (Back to Library Catalog) Diabetes USPSTF Gestational Diabetes Screening Prediabetes and Type 2 Diabetes: Screening IEHP Internal Library American Diabetes Association – Diabetes Care (PDF) National Kidney Foundation – Diabetes and Chronic Kidney Disease (PDF) HEDIS Statin Therapy for Patients with Diabetes – Adherence (SPD) Statin Therapy for Patients with Diabetes – Statin Therapy (SPD) Comprehensive Diabetes Care – HbA1C Testing (CDC) Comprehensive Diabetes Care - HbA1C Control (<=9) (CDC) Comprehensive Diabetes Care (<8) (CDC) Comprehensive Diabetes Care - Eye Exam (CDC) Comprehensive Diabetes Care – Monitoring for Nephropathy (CDC) Comprehensive Diabetes Care – Blood Pressure Control (<140/90) (CDC) MCAS Comprehensive Diabetes Care HbA1C Testing (CDC HT) Comprehensive Diabetes Care HbA1C Testing >9%) (CDC H9) (Back to Library Catalog) E (Back to Library Catalog)   F (Back to Library Catalog)   G Gonorrhea USPSTF Chlamydia and Gonorrhea Screening IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) H Hepatitis C USPSTF Hepatitis C Virus Infection in Adolescents and Adults: Screening IEHP Internal Library American Association for the Study of Liver Diseases – Hepatitis C (PDF) HEDIS N/A MCAS N/A (Back to Library Catalog) Human Immunodeficiency Virus (HIV) USPSTF HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) Hypertension USPSTF Screening for Hypertension in Adults IEHP Internal Library Joint National Committee – Hypertension Guidelines (PDF) HEDIS Controlling high blood pressure (CBP) MCAS Controlling high blood pressure (CBP) (Back to Library Catalog) I (Back to Library Catalog)   J (Back to Library Catalog)   K (Back to Library Catalog) L (Back to Library Catalog)   M (Back to Library Catalog)   N (Back to Library Catalog)   O Obesity USPSTF Weight Loss to Prevent Obesity Related Morbidity and Mortality in Adults - Counseling Screening for Obesity in Children and Adolescents Behavioral Health Counseling for Adults that are Overweight or Obese and Have Other CVD Risk Factors IEHP Internal Library N/A HEDIS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) MCAS Weight Assessment and Counseling (WCC-BMI) Adult Body Mass Index (ABA) (Back to Library Catalog) Osteoporosis USPSTF Osteoporosis to Prevent Fractures: Screening IEHP Internal Library N/A HEDIS Osteoporosis management in women who have had a fracture (OMW) MCAS N/A (Back to Library Catalog) P (Back to Library Catalog) Q (Back to Library Catalog) R (Back to Library Catalog) S Sexually Transmitted Infections USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for those at Increased Risk for Infection Chlamydia and Gonorrhea Screening HIV Screening in Pregnant Persons HIV Screening in Adults and Adolescents HIV Prevention – Preexposure Prophylaxis IEHP Internal Library Centers for Disease Control Public Health Media Library – STD Treatment You may also refer to individual topics as they appear in this library: Chlamydia Gonorrhea HIV Syphilis HEDIS Chlamydia Screening in women (CHL) MCAS Chlamydia Screening in women (CHL) (Back to Library Catalog) Skin Cancer Behavioral Counseling USPSTF Skin Cancer Prevention: Counseling IEHP Internal Library N/A HEDIS N/A MCAS N/A   (Back to Library Catalog) Smoking Cessation/Tobacco Usage USPSTF Smoking Cessation Smoking Cessation – Pharmacotherapy Lung Cancer Screening Tobacco Use in Children and Adolescents – Primary Care Interventions IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) Syphilis USPSTF Syphilis Screening in Pregnant Women Syphilis Screening for Those at Increased Risk for Infection IEHP Internal Library You may also refer to Sexually Transmitted Infections in this resource guide HEDIS N/A MCAS N/A (Back to Library Catalog) T Tuberculosis USPSTF Latent Tuberculosis Screening IEHP Internal Library N/A HEDIS N/A MCAS N/A (Back to Library Catalog) U (Back to Library Catalog) V (Back to Library Catalog) W (Back to Library Catalog) X (Back to Library Catalog) Y (Back to Library Catalog) Z (Back to Library Catalog) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

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

ht thing for you and your family when it comes to getting the care you need. For the past 25 years, we’ve made it our mission to help our Members get quality medical, behavioral health and wellness  services. Who is IEHP? IEHP is a managed care health plan. We launched in 1996 with 62,000 Medi-Cal Members and today we have grown to become one of the top 10 largest Medi-Cal health plans. With a network of more than 8,000 Providers and more than 2,000 employees, IEHP serves more than 1.4 million residents in Riverside and San Bernardino counties). We work with doctors, hospitals, and other health care Providers in your area to give improved health care coordination and quality of care to our Members. What benefits do I get as an IEHP Member? A network of more than 8,000 Doctors, Specialists and other health care Providers Care coordination 24-Hour Nurse Advice Line Vision services Urgent Care centers Healthy lifestyle classes and programs And so much more! For more information on IEHP’s benefits and services, contact IEHP Member Services. Can I still have Medi-Cal as an IEHP Member? Yes, you will still have Medi-Cal and all the benefits and services you had before, such as no monthly premiums and zero cost for Doctor visits, medicines and hospital stays. The only difference is that your health care services will now be coordinated through IEHP. Other Medi-Cal services include preventive care, such as vaccines and screenings for mental health, development and substance abuse disorders. You can get Fee-For-Service Medi-Cal dental services through the Medi-Cal Dental Program. Can I stay with my same Doctor when I join IEHP? If he or she is part of IEHP’s Provider Network, you will be able to continue to get care from the same Doctor. You can check this by calling IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. If you also have Medicare, you can keep seeing your doctors whose services are provide by Medicare. Who we are Our Mission We heal and inspire the human spirit.  Our Vision We will not rest until our communities enjoy optimal care and vibrant health.  Our Values We do the right thing by: Placing our Members at the center of our universe. Unleashing our creativity and courage to improve health & well-being.  Bringing focus and accountability to our work.  Never wavering in our commitment to our Members, Providers, Partners, and each other. We’re here to answer your questions and help you get started on your journey to good health.

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

M Members 7K+ Providers 3K+ Team Members

ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. You can also file a grievance. Ask your Doctor for a form or select from the options below. GRIEVANCE FORM Print and mail grievance form (PDFs are below) Call IEHP Member Services and we will mail you a form If you are mailing your grievance form please send it to: IEHP, Attention: Grievance Dept. P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.   Medi-Cal Member Complaint Form (PDF) IEHP DualChoice (HMO D-SNP) Complaint Form Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.  

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

ces and feedback guide our services. As a result, we are able to improve how we deliver care and services. The PPPC meets every three months. We bring together IEHP staff and Members to give our Members a platform for open discussion. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss the IEHP Cultural and Linguistic (C&L) services program. Members who are selected to participate, will get $75 for each meeting they attend. All meetings will take place at IEHP headquarters from 12 p.m. - 2 p.m.   2023 Meeting Schedule March 15, 2023 June 21, 2023 September 20, 2023 December 20, 2023  

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

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

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

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

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

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

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

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