Search Results For : " UNIVERSITY OF BIRMINGHAMBIRMIN "
Join Our Network - IPA
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2589 E Washington Blvd.,
Pasadena, CA 91107
(626) 817-9217
(626) 817-9207
Dignity Health Medical Network - Inland Empire
3400 Data Drive,
Rancho Cordova, CA 95670
(916) 851-2026
(916) 851-7642
LaSalle Medical Associates
1855 W. Redlands Blvd. 2nd Floor,
Redlands, CA 92373
(888) 554-4562
(626) 943-6369
Optum Care Network - Inland Faculty MG
1860 Colorado Blvd. Ste 200,
Los Angeles, CA 90041
(800) 371-7547
(323) 257-7329
Physicians Health Network
P.O. Box 11429,
San Bernardino, CA 92423
(909) 300-5030
(909) 332-5555
Horizon Valley Medical Group
18564 US Highway 18 Ste 105,
Apple Valley, CA 92307
(760) 813-6950
(760) 813-6947
DualChoice CalMediConnect
CPN - Horizon Valley Medical Group
18564 US Highway 18 Ste. 105,
Apple Valley, CA 92307
(760) 242-7777
(760) 242-0487
Dignity Health Medical Network - Inland Empire
3400 Data Drive,
Rancho Cordova, CA 95670
(916) 851-2026
(916) 851-7642
EPIC Health Plan
1615 Orange Tree Lane,
Redlands, CA 92374
(909) 799-1818
(909) 786-0816
Alliance Desert Physicians, Inc.
Beaver Medical Group
Chaffey Medical Group
FENIX Medical Group
Pinnacle Medical Group
Redlands - Yucaipa Medical Group
TriValley Medical Group
Heritage Provider Network
8510 Balboa Blvd. Ste 275,
Northridge, CA 91325
(818) 654-3461
Desert Oasis Healthcare
275 N El Cielo Rd.,
Palm Springs, CA 92262
(760) 320-8814
Heritage Victor Valley Medical Group
12370 Hesperia Rd.,
Victorville, CA 92395
(760) 245-4747
Regal Medical Group
621 E Carnegie Dr. Ste 140,
San Bernardino, CA 92408
(818) 654-3400
PrimeCare, part of Optum Care
3990 Concourse St.,
Ontario, CA 91764
(909) 605-8000
PrimeCare Chino
15315 Fairfield Ranch Rd. Ste 275,
Chino Hills, CA 91709
(909) 465-1397
(909) 465-6629
Optum Care Network - Citrus Valley
9130 Anaheim Place Ste 130,
Rancho Cucamonga, CA 91730
(909) 466-8000
(909) 484-6825
Optum Care Network - Corona
2275 Sampson Ave. Ste 111,
Corona, CA 92879
(951) 371-8440
(951) 371-3910
Optum Care Network - Hemet Valley
41391 Kalmia St. Ste 310,
Murrieta, CA 92562
(951) 461-0762
(951) 698-5194
Optum Care Network - Inland Valley
9130 Anaheim Pl. Ste 130,
Rancho Cucamonga, CA 91730
(909) 466-8000
(909) 484-6825
Optum Care Network - Moreno Valley
1467 Ford St. Ste 103,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Redlands
1520 Barton Rd.,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Riverside
2275 Sampson Ave. Ste 111,
Corona, CA 92879
(951) 371-8440
(951) 371-3910
Optum Care Network - San Bernardino
1467 Ford St. Ste 103,
Redlands, CA 92373
(909) 798-7766
(909) 792-8627
Optum Care Network - Sun City
41391 Kalmia St. Ste 310,
Murrieta, CA 92562
(951) 461-0762
(951) 698-5194
Optum Care Network - Southwestern Valleys
41391 Kalmia St. Ste 310,
Murrieta, CA 92562
(951) 461-0762
(951) 698-5194
Optum Care Network - Valley Physicians
24630 Washington Ave. Ste 203,
Murrieta, CA 92562
(951) 704-1900
(877) 397-7682
Riverside Medical Clinic
3660 Arlington Ave.,
Riverside, CA 92506
Provider Resources - Clinical Practice Guidelines
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.
Provider Resources - Utilization Management Criteria
e. IEHP has created UM Subcommittee Approved Authorization Guidelines to serve as one of the sets of criteria for medical necessity decisions. Our goal in creating this page is to provide you with easily accessible electronic versions of IEHP’s UM guidelines. IEHP utilizes a variety of sources in developing our UM guidelines which include:
Medicare and Medi-Cal’s coverage policy statements
Evidence in the peer-reviewed published medical literature
Technology assessments and structured evidence reviews
Evidence-based consensus statements
Expert opinions of healthcare Providers
Evidence-based guidelines from nationally recognized professional healthcare organizations and public health agencies.
IEHP is also licensed to use MCG Guidelines, Apollo Medical Review Criteria, and InterQual to guide in utilization management decisions.
Since medical technology is constantly evolving, our clinical guidelines are subject to change without prior notification. Additional UM Subcommittee Guidelines may be developed as needed or may be withdrawn from use.
Please note that benefits may vary based on Member’s line of business; therefore, certain services discussed in the UM Subcommittee Guidelines may not be a covered benefit.
Table of Contents (PDF)
Providers may obtain information about criteria, either in general or relating to specific UM decisions, from IEHP upon request by contacting the IEHP UM Department. Please contact the IEHP Provider Relations Team at (909) 890-2054 to be connected to the UM Department.
Behavioral Health
Behavioral Health Treatment (BHT) Criteria (PDF)
Behavioral Health Home Based Services (PDF)
Criteria for Multidisciplinary Diagnostic Treatment (PDF)
Community Supports Services
Community Transition Services Nursing Facility Transition to a Home (PDF)
Nursing Facility Transition-Diversion to Assisted Living (PDF)
Housing Deposits (PDF)
Housing Transition Navigation Services (PDF)
Housing Tenancy and Sustaining Services (PDF)
Asthma Remediation (PDF)
Environmental Accessibility Adaptations (Home Modifications) (PDF)
Medically Tailored Meals (PDF)
Sobering Centers (PDF)
Recuperative Care (PDF)
Short-Term Post-Hospitalization Housing (PDF)
Diagnostic Testing
Elastography (PDF)
Inflammatory Bowel Disease Serology (PDF)
Vestibular Autorotation Test (PDF)
Gynecology and Obstetrics
Fetal Non-Stress Testing (PDF)
Neurology
Bone Marrow Transplant in Treatment of Multiple Sclerosis (PDF)
Pain Management
Pain Management - Centers of Excellence (COE) (PDF)
Referrals to Pain Management Specialist (PDF)
Pharmacy
Biosimilar Products (PDF)
CAR-T Therapy (PDF)
Surgical Procedures
Adolescent Bariatric Consultation and Surgery (PDF)
Bronchial Thermoplasty (PDF)
Liver Biopsy in Conjunction with Bariatric Surgery (PDF)
Natural Orifice Transluminal Endoscopic Surgery (PDF)
Transgender Services (PDF)
Other
Allocation of Limited Critical Care Resources During a Public Health Emergency (PDF)
Care Plan Option (PDF)
Complementary and Alternative Medicine or Holistic Therapies (PDF)
Congregate Living Health Facilities (PDF)
Criteria for Custodial Care: Medi-Cal (PDF)
Enhanced Care Management (PDF)
Hair Removal Guideline (PDF)
Health Homes Program (HHP) (PDF)
My Path (A Palliative Care Approach) (PDF)
Tertiary Care Center Referral Requests (PDF)
Transitional Care Medicine (PDF)
Transportation Criteria (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.
Provider Resources - Claims
d range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link (By clicking on this link, you will be leaving the IEHP website) https://learn.medi-cal.ca.gov/.
Medi-Cal Rates and Codes
By clicking on these links, you will be leaving the IEHP website.
Medi-Cal Rates
The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system.
Resource: website
CPT Codes
This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits.
Resource: website
Alpha-Numeric HCPCS Files
These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.
Resource: website
ZIP code To Carrier Locality File
This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS.
Resource: website
Medicare Physician Fee Schedule
Information on services covered by the Medicare Physician Fee Schedule (MPFS).
Resource: website
IEHP Fee Schedule
IEHP Fee Schedule - December 08, 2020 (PDF)
Other Health Coverage (OHC)
Coordination of Benefits with Other Health Coverage (OHC) (PDF)
Frequently Asked Questions (FAQs) - OHC (PDF)
Care After Hours - Get Care After Hours
hen you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care.
Call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711.
1. Speak to our Nurse
Our Nurse can offer you medical advice on the phone or guide you to get the care you need.
Common reasons to call our Nurse:
Cough
Mild stomach ache
Mild fever
Sore throat
Cold or flu
Questions about your medicine
Ear ache
Nurse Advice Video
2. Speak to a Doctor
Our Nurse may decide you need to talk with a Doctor. If so, our Nurse will connect you with a Doctor for a live phone chat or schedule a virtual visit through an app.
3. Visit an IEHP Urgent Care Clinic
Our Nurse may direct you to an Urgent Care Clinic, so you can see a Doctor the same day. Many clinics are open late, weekends and holidays. Some clinics have X-rays and lab tests. We have more than 90 Urgent Care Clinics in our network. For one near you, visit the IEHP Provider Search.
Common reasons to visit an Urgent Care Clinic:
Mild sore throat
Mild fever
Rash
Nose bleed
Minor trauma
Animal or insect bite
Asthma (non-critical)
Cuts & lacerations
Call 911 or go to the nearest Emergency Room (ER) for emergency medical and behavioral health conditions. Don’t wait!
Urgent Care Video
Helpful Information and Resources - Emergency Safety
y when there is a power shutoff or fire. We want to ensure you get the needed care and services to help you during these events. If you are impacted by these events and need help with your durable medical equipment (such as wheelchairs, ventilators, oxygen monitors, etc.) call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. If you need a medicine refill, go to your pharmacy and request a refill. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY).
How to prepare for an emergency.
Public Safety Power Shutoff Alerts
A Public Safety Power Shutoff, also called a PSPS, occurs in response to severe weather. Power is turned off to help prevent wildfire and keep communities safe. We encourage you to sign up for alerts so you know when a Public Safety Power Shutoff may occur and when your power is restored.
Click here to sign up.
Medicine Safety
Some medicines may need to be stored in a refrigerator to keep their strength, including many liquid medicines. When the power is out for a day or more, throw away any medicines that should be refrigerated, unless the medicines label says otherwise. If a life depends on the refrigerated medicines (for example, insulin), use them only until a new supply is available. Replace all refrigerated medicines as soon as you can.
Resources
Refrigerated Medicine Storage (PDF)
Insulin Storage and Product Switching in an Emergency (PDF)
Comparison of Insulins (PDF)
Durable Medical Equipment Safety
Use the checklist below to prepare for a power outage.
Check your backup power equipment frequently to ensure it will function during an emergency.
Call your power and water companies about your needs for life-support devices (home dialysis, suction, breathing machines, etc.) in advance of a disaster. Many utility companies keep a “priority reconnection service” list and map of the locations of power-dependent customers for use in an emergency. Ask the customer service department of your utility companies if this service is available.
Keep the shut-off switch for oxygen equipment near you so you can get to it quickly in case of emergency.
Generator users should operate generators in open areas to ensure good air circulation.
Test generators once a month, and take your generator to be serviced at least once a year, to make sure it will work when needed.
Create a plan for how to recharge batteries when the power is out. Reference resources below.
When power is restored, make sure the settings on your medical device have not changed.
Resources
Emergency Power Planning for a Durable Medical Equipment Checklist (PDF): this booklet helps you establish a plan to obtain and organize your medical device information.
How to Prepare for and Handle Power Outages for Medical Devices that Require Electricity - FDA
Emergency Power Planning for People Who Use Electricity and Battery Dependent Assistive Technology and Medical Devices: this checklist will help you create a plan for your electric and battery-dependent devices.
Mental Health
If you have been impacted by a fire and need mental health, related to stress or grief, call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm (PST), Monday-Friday. TTY users should call 1-800-718-4347. For medical advice after-hours, please call the IEHP 24-Hour Nurse Advice Line at 1-888-244-4347 or 711 (TTY).
Additional Tips
Build or restock your emergency supply kit, including food, water, flashlights, a radio, fresh batteries, first aid supplies and cash. Click here to find local resources that help you build an emergency supply kit.
Identify backup charging methods for phones such as a battery power pack, a car charger and solar battery charger.
Learn how to manually open your garage door. Create a plan based off what you can do by yourself and what you will need help with.
Create an emergency contact list.
If you own a backup generator, ensure it is ready to safely operate.
Create an emergency action plan that includes evacuation planning for your home, family and pets.
Resources
https://www.sce.com/wildfire: how to safety prepare for a wildfire
https://www.sce.com/wildfire/psps: Power Safety Power Shutoff resources
https://prepareforpowerdown.com/: how to prepare for a power shutoff
http://www.jik.com: emergency preparedness information prepared by Jule Kiles
https://www.readyforwildfire.org/prepare-for-wildfire/get-set/: how to prepare for a wildfire
Emergency Supplies Kits for People with Disabilities and Activity Limitations: checklist suggests emergency kit contents including no cost supplies, that you can tailor to your needs and abilities.
Emergency Evacuation Preparedness: Taking Responsibility For Your Safety, A Guide For People with Disabilities and Other Activity Limitation: how to develop plans that integrates people with disabilities and others with access and functional needs.
Emergency Health Information: Savvy Health Care Consumer Series: a guide to develop your emergency health information.
Emergency Travel Safety Tips for Overnight Stays: a guide for people with disabilities.
Tips for Emergency Use of Mobile Devices: preparing your device for an emergency.
Senior Health - Advanced Care Planning
ing is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you.
MY LIFE. MY CHOICE. is IEHP’s Advance Care Planning program for IEHP DualChoice Members. The online program helps you fill out Advance Care Directive forms and gives you a place to keep them safe to share with your Doctor. IEHP can also store related documents like Physician Orders for Life-Sustaining Treatment, Living Wills, Health Care Power of Attorney and Do Not Resuscitate forms. MY LIFE. MY CHOICE. is accessible through the IEHP Member Portal. You can easily upload your Advance Care Directives and access them at any time from your home computer or smartphone. You can also share your forms with your family, friends and caregivers by email, SMS and fax. If you get sick and cannot make medical decisions, having these documents lets others know your wishes about medical care. This ensures you get the treatment and medical care you want.
You can learn more about Advance Care Planning by accessing MY LIFE. MY CHOICE. through the IEHP Member Portal OR attending an in-person workshop.
Register online:
Log in to the Member portal.
Log in to MY LIFE. MY CHOICE.
Follow the steps to begin your Advance Care Planning.
Register for an in-person workshop:
Log in to the Member portal at www.iehp.org.
Click the Health & Wellness tab.
Choose “Senior Health” for a list of workshops with dates and times.
Choose the workshop you want to attend.
For assistance with MY LIFE. MY CHOICE. please call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.
Care After Hours - Emergency Room vs. Urgent Care Clinic
iding between the ER and Urgent Care. For medical advice before visiting the ER or an Urgent Care Clinic, you can call your Doctor or IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711. Note that ERs are open 24 hours a day and many Urgent Care clinics close in the late evening.
When Should I Go to the ER?
An emergency is when a person could die or be permanently hurt. The ER provides care for critical or life-threatening conditions.
Visit your closest ER or call 911 if you experience:
Changes in mental status, such as confusion
Chest pain or pressure
Coughing or vomiting blood
Difficulty breathing or shortness of breath
Severe allergic reaction
Severe or persistent vomiting or diarrhea
Sudden dizziness, weakness or changes in vision
Sudden or severe pain
Visit Provider Search for listing of emergency room locations near you.
When Should I go to an Urgent Care?
Go to an Urgent Care Clinic when you need care after hours for non-life-threatening conditions.
Here are some examples of conditions:
A common illness like the flu
Minor fever or headache
Painful sore throat
Earache or sinus pain
Minor injuries like a sprained ankle
Back pain
Cuts or small wounds
Small burns
Rash or minor allergic reactions
Nausea
Diarrhea
Urinary tract infections
There are more than 90 clinics in our IEHP network. Many are open late and on weekends. Search Provider Search or call the IEHP 24-Hour Nurse Advice Line (888) 244-4347, TTY 711.
Urgent Care and Medi-Cal
ic of the moment, it may not always be clear where to go to get help. Besides the worry of the injury or illness itself, you may also be thinking, “does Medi-Cal cover urgent care?”
Finding an urgent care clinic that takes Medi-Cal is not the only priority. You also need to think about what kind of treatment you need and where to go to get it. Consider the following example:
It is a Saturday morning, and you have a severe stomachache and now start to have a fever. You want to get medical treatment as soon as possible but know your Doctor is closed on the weekend. So, you are not sure whether to go to an urgent care clinic or the emergency room. You also want to make sure there are urgent care clinics nearby that accepts Medi-Cal.
Yes, many urgent care clinics do accept Medi-cal. At IEHP we have over 90 urgent care clinics in our network that offer Members care afterhours, on weekends and on holidays, when your primary care doctor might be closed. Click here to search for an IEHP urgent care clinic in your area.
Now, that you know that urgent care clinics accept Medi-Cal, let’s review when you might need urgent vs emergency care.
Urgent Care vs. Emergency Room
Urgent care is not the same as emergency care. Urgent care centers are for illnesses and injuries that are not life-threatening, yet still require treatment. Some examples include common illness like the flu, minor fever or headache, painful sore throat, earache or sinus pain, back pain, minor injuries like a sprained ankle, etc. Most urgent care centers provide same-day services and usually have shorter waiting times than emergency rooms.
Emergency rooms (ER) are for life-threatening emergencies and accidents where immediate treatment is required. Emergency rooms are open 24 hours a day 7 days a week and provide care for critical or life-threatening conditions. Visit your nearest ER or call 911 if you experience: changes in mental status, such as confusion, chest pain or pressure, coughing or vomiting blood, difficulty breathing or shortness of breath etc.
When to Visit Urgent Care
Urgent care clinics are not a substitute for your regular doctor. When you can't reach your Doctor after-hours or your Doctor is not available, you have options to get your needed care. Many people don’t realize there is a middle ground between a doctor’s visit and a trip to the ER.
Urgent care centers regularly handle a range of medical problems, including:
Fevers
Dehydration
Small wounds
Vomiting/diarrhea
Sprains
Allergies
Bites
Cold or flu symptoms
Emergency rooms handle life threatening conditions, including:
Head injuries
Broken bones
Chest pains
Breathing difficulties
Heart attack
Stroke
Serious burns
Serious bleeding
Be Prepared
Does urgent care take medical history into account? Absolutely! Your medical records form an important part of your treatment and follow-up care. As such, we always recommend you are ready with the following details:
Information on pre-existing conditions.
Details of past surgeries, when you had them, and which hospital and doctors performed them.
A list of prescription medications you take, the dosage, and how often you take them.
A list of any over-the-counter medications you take, the dosage, and how often you take them.
Any allergies you have.
Make sure to bring your IEHP Member Card
While nobody likes to think about being in an accident or suffering a sudden illness, it is important to be prepared. Your Doctor understands your health and medical background. Doctors at urgent care clinics will not have access to the same depth of information as your primary doctor, therefore, we recommend you that you follow up with your primary care Doctor after visiting an urgent care.
After-Hour and Urgent Care Services for IEHP Members
If you think you need urgent care, it’s always recommended to call your doctor’s office. If your doctor’s office is closed, you can call the IEHP 24-Hour Nurse Advice Line at (888) 244-4347, TTY 711, or click here to search for an IEHP Urgent Care clinic.
Of course, always call 911 if immediate medical care is needed. At IEHP, we pride ourselves on improving lives by delivering quality and accessible healthcare and will not rest until our communities enjoy optimal care and vibrant health. If you have any questions about your Medi-Cal benefits please call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347 to learn more.
Medi-Cal Evidence of Coverage Updates
book for the benefit year of January 1, 2022 – December 31, 2022.
How to get care
Sensitive care
Minor consent services
You may only get the following services without your parent or guardian’s permission if you are 12 years old or older:
Outpatient mental health care for (minors age 12 or older):
Sexual assault (no lower age limit)
Incest
Physical assault
Child abuse
When you have thoughts of hurting yourself or others (minors age 12 or older)
HIV/AIDS prevention/testing/treatment
Sexually transmitted infections prevention/testing/treatment
Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook.
If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care:
Pregnancy
Family planning/birth control
Abortion services
For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the IEHP network. You
can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711).
Minors can talk to a representative in private about their health concerns by calling the 24/7 at 1-888-244-IEHP (4347) (TTY 711).
Benefits and services
What your health plan covers
This chapter explains your covered services as a member of IEHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask IEHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call IEHP Member Services at 1-800-440-IEHP (4347) (TTY 1-800-718-4347 or 711).
Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information.
Some of the basic health benefits IEHP offers are listed below. Benefits with a star ( * ) may need pre-approval.
Acupuncture*
Acute (short-term treatment) home health therapies and services
Adult immunizations (shots)
Allergy testing and injections
Ambulance services for an emergency
Anesthesiologist services
Asthma prevention
Audiology*
Behavioral health treatments*
Cardiac rehabilitation
Chiropractic services*
Chemotherapy & Radiation therapy
Cognitive health assessment
Dialysis/hemodialysis services
Durable medical equipment (DME)*
Emergency room visits
Enteral and parenteral nutrition*
Family planning office visits and counseling (you can go to a non-participating provider)
Habilitative services and devices*
Hearing aids
Home health care*
Hospice care*
Inpatient medical and surgical care*
Lab and radiology*
Long-term home health therapies and services*
Maternity and newborn care
Major organ transplant*
Occupational therapy*
Orthotics/prostheses*
Ostomy and urological supplies
Outpatient hospital services
Outpatient mental health services
Outpatient surgery*
Palliative care*
PCP visits
Pediatric services
Physical therapy*
Podiatry services*
Pulmonary rehabilitation
Rapid Whole Genome Sequencing
Rehabilitation services and devices*
Skilled nursing services
Specialist visits
Speech therapy*
Surgical services
Telemedicine/Telehealth
Transgender services*
Urgent care
Vision services*
Women’s health services
MediCal Open Access Program - Open Access Program
a better life, and a better future. Many children enter foster care with a list of physical or behavioral health concerns. Due to changing placements, these concerns often go untreated. By speeding up the process to see a Doctor, the Open Access Program makes it simple for your child to get ongoing medical care. No matter where you live in the Inland Empire, your child can see any Doctor in the network. Plus, our program gives your child many services you won’t find with the Regular Medi-Cal system.
How Open Access makes it simpler for your child to get healthcare:
Your child can see any PCP in our large network.
You can switch Doctors any time, for any reason. IEHP will help you find one. Call 1-800-440-IEHP (4347) / TTY (800) 718-4347.
The Program gives your Doctor a record of your child’s health history (shots, medicines, checkups) so there’s no guesswork.
If you misplaced your IEHP Member ID Card or Beneficiary Identification Card (BIC), an Open Access Doctor can go online and quickly confirm your child’s eligibility.
You and your child get extra services at no cost:
Keep your child feeling well with no-cost Wellness Programs like asthma or diabetes.
Keep your child safe and healthy and get extras a parent enjoy like an infant car seat, children’s vitamins, and a bicycle helmet.
A team helps you care for your child with a chronic illness. Working with your child’s Doctor, we call you, making sure your child gets the right care. We even lend a hand if things like Doctor visits, lab tests or medicine pile up.
Important Resources
Open Access Provider Directory (PDF)
To get more information about the Open Access Program call an IEHP Foster Care Specialist at (800) 706-4347, Monday–Friday, 8am-5pm.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy. Click Adobe Acrobat Reader.
Complex Care Management
Do you need help coordinating care with your Doctors? IEHP can help. Our Complex Care Management (CCM) Program was designed to assist Members who are ill. This includes a serious illness, like heart disease, lung disease, kidney disease, AIDS, Hepatitis C, spinal injury or any other chronic uncontrolled condition.
IEHP’s Care Management Team will work with you and your Doctor to make sure you get the care you need. We can help you manage your illness and medicines, coordinate care, work with your Providers and help you to get any needed medical equipment. We also offer and invite you to make use of an Interdisciplinary Care Team (ICT) to help you with your personalized plan of care. This Team consists of your Primary Care Doctor, Complex Care Manager and others who support your health care needs.
You may be referred to the CCM program through the following options:
Medical Management Program Referral
Discharge Planner Referral
Practitioner Referral
Caregiver Referral
Self-Referral
How to opt in to the CCM program
First, we will need to complete a health survey with you to assess your needs. This will help determine if you are eligible for the program. If you are eligible for the program and wish to opt in, you will be automatically enrolled. If you are not eligible for the CCM program but want more information on other Care Management Services available, please contact IEHP Member Services at 1-800-440-4347.
After enrollment into the CCM program, you will be assigned a Primary Case Manager. The Case Manager will contact you at least once every 30 days to discuss your health goals. They will also assist you with a plan to meet those goals.
To get started, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.
How to opt out of the CCM Program
Once enrolled, you may opt out of the program at any time. Simply contact IEHP Member Services at 1-800-440-4347 and let them know you no longer wish to be involved with the program. Be sure to notify your Case Manager as well.
Helpful Information and Resources - Personal Injuries and Accidents
l eligible, Please contact the Department of Health Care Services at (916) 445-9891 or visit DHCS.ca.gov/PI.
Operating hours: 8am – 12pm and 1pm – 5pm, Monday through Friday. Closed on weekends and holidays.
Mailing address:
Department of Health Care Services
Third Party Liability and Recovery Division
Casualty Insurance Section – MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
IEHP DualChoice (HMO D-SNP) Medicare-Medicaid Plan Members
If you are a Medicare Member and would like to report a potential liability settlement, judgment, award or other payment you have received, or to request your Protected Health Information, please click here for Authorization of Release (PDF).
Report an Issue - Report a problem with your care
ppy or you are having problems with your care, talk to your Doctor. Your Doctor will help you. If you need more help, call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.
You can also file a grievance. Ask your Doctor for a form or select from the options below.
GRIEVANCE FORM
Print and mail grievance form (PDFs are below)
Call IEHP Member Services and we will mail you a form
If you are mailing your grievance form please send it to:
IEHP, Attention: Grievance Dept.
P.O. Box 1800
Rancho Cucamonga, CA 91729-1800
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.
Medi-Cal Member Complaint Form (PDF)
IEHP DualChoice (HMO D-SNP) Complaint Form
Within 5 days of getting your complaint, we will send you a letter letting you know we received it. Within 30 days, we will send you another letter that tells you how we resolved your problem. If you call IEHP about a grievance that is not about health care coverage, medical necessity, or experimental or investigational treatment, and your grievance is resolved by the end of the next working day, you may not receive a letter.
Helpful Information and Resources - Holiday Schedule
January 2, 2023
Martin Luther King, Jr. Day - Monday, January 16, 2023
President's Day - Monday, February 20, 2023
Memorial Day - Monday, May 29, 2023
Juneteeth - Monday, June 19, 2023
Day before Independence Day - Monday, July 3, 2023
Independence Day - Tuesday, July 4, 2023
Labor Day - Monday, September 4, 2023
In observance of Veteran's Day - Friday, November 10, 2023
Thanksgiving Day - Thursday, November 23, 2023
Day after Thanksgiving - Friday, November 24, 2023
Christmas Day - Monday, December 25, 2023
IEHP DualChoice - How to Access Care
ited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which IEHP DualChoice (HMO D-SNP) authorizes use of out-of-network providers.
What are Network providers?
Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment as payment in full. We have arranged for these providers to deliver covered services to members in our plan.
All of our plan participating providers also contract us to provide covered Medi-Cal benefits.
Find a Doctor
Use the IEHP DualChoice Provider and Pharmacy Directory below to find a network provider:
2023 IEHP DualChoice Provider and Pharmacy Directory (PDF)
What is a Primary Care Provider (PCP) and their role in your Plan?
A PCP is your Primary Care Provider. You will usually see your PCP first for most of your routine health care needs. Your PCP will also help you arrange or coordinate the rest of the covered services you get as a member of our Plan. "Coordinating" your services includes checking or consulting with other Plan providers about your care and how it is going. This includes:
your X-rays
laboratory tests, therapies
care from doctors who are specialists
hospital admissions, and follow-up care
Primary Care Providers (PCPs) are usually linked to certain hospitals. When you choose your PCP, remember the following:
You must choose your PCP from your Provider and Pharmacy Directory. Call IEHP DualChoice Member Services if you need help in choosing a PCP or changing your PCP.
Choose a PCP that is within 10 miles or 15 minutes of your home.
The PCP you choose can only admit you to certain hospitals. Try to choose a PCP that can admit you to the hospital you want within 30 miles or 45 minutes of your home.
Some hospitals have “hospitalists” who specialize in care for people during their hospital stay. If you are admitted to one of these hospitals, a “hospitalist” may serve as your caregiver as long as you remain in the hospital. When you are discharged from the hospital, you will return to your PCP for your health care needs.
If you need to change your PCP for any reason, your hospital and specialist may also change. Your PCP should speak your language. However, your PCP can always use Language Line Services to get help from an interpreter, if needed.
If you do not choose a PCP when you join IEHP DualChoice, we will choose one for you. We will send you your ID Card with your PCP’s information. Remember, you can request to change your PCP at any time.
You can switch your Doctor (and hospital) for any reason (once per month). If your change request is received by IEHP by the 25th of the month, the change will be effective the first of the following month; if your change request is received by IEHP after the 25th of the month, the change will be effective the first day of the subsequent month (for some providers, you may need a referral from your PCP).
How to Get Care from a Specialist
You will usually see your Primary Care Provider (PCP) first for most of your routine healthcare needs such as physical check-ups, immunization, etc. When your PCP thinks that you need specialized treatment or supplies, your PCP will need to get prior authorization (i.e., prior approval) from your Plan and/or medical group. This is called a referral. Your PCP will send a referral to your plan or medical group. It is very important to get a referral (approval in advance) from your PCP before you see a Plan specialist or certain other providers. If you don't have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself.
What if you are outside the plan’s service area when you have an urgent need for care?
Suppose that you are temporarily outside our plan’s service area, but still in the United States. If you have an urgent need for care, you probably will not be able to find or get to one of the providers in our plan’s network. In this situation (when you are outside the service area and cannot get care from a network provider), our plan will cover urgently needed care that you get from any provider.
Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States.
Changing your Primary Care Provider (PCP)
You may change your PCP for any reason, at any time. Also, it’s possible that your PCP might leave our plan’s network of providers and you would have to find a new PCP. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services. IEHP DualChoice Member Services can assist you in finding and selecting another provider. You can change your Doctor by calling IEHP DualChoice Member Services. Please call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call (800) 718-4347.
For more information on network providers refer to Chapter 1 of the IEHP DualChoice Member Handbook.
IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader.
Information on this page is current as of October 01, 2022
H8894_DSNP_23_3241532_M
Healthy Living - Flu
at you can to protect yourself from the flu virus. Everyone should get the flu shot. Members who are especially high risk for complications are:
65 years of age or older.
Pregnant.
Residents of nursing homes and long-term care facilities.
Children, 6 months or older.
Remember, in many cases, the flu shot can prevent the flu, lessen the symptoms if you get the flu and reduce spreading it to others.
Common myths about the flu shot
Myth 1: I can get the flu from the flu shot.
False. The flu shot is made from a virus that is not active, so it doesn’t cause infection.
Myth 2: I’m healthy; I don’t need the flu shot.
False. Healthy people can get sick, too. Very sick. The flu shot can help lower your chances of getting sick.
Myth 3: I got a flu shot last year. I don’t need a shot this year.
False. The flu virus changes every year and so does the flu shot. You need a flu shot every year to fight this year's flu.
Frequently Asked Questions
Q: Where can I get the flu shot?
A: Your Doctor’s office (for adults and children), certain network pharmacies like CVS, Rite Aid and Walgreens (for adults only).
Q: What are ways I can avoid getting the flu?
A: To avoid getting the flu, you should:
Get the flu shot.
Avoid close contact with people who are sick.
Wear something to cover your mouth and nose when in public.
Wash your hands often with soap and water. If you don't have soap and water, use an alcohol-based hand sanitizer.
Avoid touching your eyes, nose, and mouth.
Eat healthy.
Drink lots of fluids, especially water.
Get plenty of rest.
Clean and disinfect surfaces around you.
Q: What should I do if I get the flu?
A: If you get the flu, be sure to:
Stay home and rest.
Avoid others.
Drink lots of fluids, like water and juice.
See your Doctor if symptoms do not improve.
If you have the flu but can’t reach your Doctor, call the IEHP 24-Hour Nurse Advice Line at 1-888-244-IEHP (4347) or 711 for TTY users. Our nurses can connect you with a Board-Certified Doctor by telephone or virtual visit via video chat.
Helpful Information and Resources - Texting Program
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
Rx Prior Authorization Drug Treatment Criteria - Prior Authorization Drug Treatment
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.
Medicare:
For IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan - Formulary and Criteria information, please click here IEHP DualChoice (HMO D-SNP).
Medicaid:
On January 7, 2019, Governor Gavin Newsom issued Executive Order N-01-19 (EO-N-01-19) for achieving cost-savings for drug purchases made by the state. A key component of EO N-01-19 requires the Department of Health Care Services (DHCS) transition all Medi-Cal pharmacy services from managed care (MC) to fee for service (FFS).
Click here to go to the “DHCS Medi-Cal Rx” page on IEHP website
Click here to go to “Medi-Cal Rx: Transition” page on DHCS website
Updated April 7, 2021, this document describes DHCS’ multi-faceted pharmacy transition policy, inclusive of “grandfathering” previously approved PAs from managed care and fee-for-service, as well as a 180-day period with no PA requirements for existing prescriptions, to help support the Medi-Cal Rx transition. During this transition period, Magellan will provide system messaging, reporting and outreach to provide for a smooth transition to Medi-Cal Rx.
Click here to view “Medi-Cal Rx Pharmacy Transition Policy” from DHCS website
To view Drug Criteria Referenced in Summary Table - Click Links Below:
Clinical Practice Guidelines - CPGs
Drug Prior Authorization Criteria
HP Acthar (repository corticotropin injection) (PDF)
Nucala (PDF)
Spinraza (nusinersen) (PDF)
Synagis (PDF)
Xolair (omalizumab) (PDF)
Drug Class Prior Authorization Criteria
Adult Enteral Nutritional Supplement (PDF)
Antineoplastic Agents (PDF)
Erythorpoieses-Stimulating Agents (PDF)
Growth Hormones (PDF)
Hepatitis C (PDF)
Hereditary Angioedema (PDF)
Immuno Globulins (PDF)
Nutritional Supplement Infant Formula (PDF)
Opioid Analgesics (PDF)
Pediatric Enteral Nutritional Supplement (PDF)
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor (PDF)
Testosterone Hormone Replacement (PDF)
Therapeutic Agents in Rheumatic And Inflammatory Diseases (PDF)
Pharmacy Policies
Discharge Policy (PDF)
Drug Trial and Failure (PDF)
High Daily Morphine Milligram Equivalent (PDF)
IEHP Drug Prior Authorization Policy (PDF)
Intradialytic Parenteral Nutrition (IDPN) Policy (PDF)
Non-Formulary Drug (PDF)
Non-Sterile Compounded Medication (PDF)
Off-Label Indication Policy (PDF)
Pharmacy Drug Management Program for Pain (PDF)
Quantity Limit Policy (PDF)
Information on this page is current as of January 1, 2022.
Latest News - Public Notice for the Regular Meeting of the Joint Powers Agencies
AN AND IEHP HEALTH ACCESS.
Date of Meeting:
November 8, 2021
Time of Meeting:
9:00 AM
Location of Meeting:
Inland Empire Health Plan
Headquarters
10801 Sixth Street, Suite 120
Rancho Cucamonga, California 91730
This Notice shall confirm the REGULAR MEETING of the Joint Powers Agencies - INLAND EMPIRE HEALTH PLAN AND IEHP HEALTH ACCESS.
If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. – 5:00 p.m.)
Agenda
Copies of the Packet may be obtained here.