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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
Member Advisory Committee - Public Policy Participation Committee
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
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
Pharmacy Pain Management - Pharmacy Pain Management
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
Pharmacy Services - Pharmacy Network Lists
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.
Physician Wellness - Physician Wellness
th IEHP’s inspiring and compelling Mission to “Heal and Inspire the Human Spirit,” we are mindful of the cost of caring on clinician health and well-being and we want you to know we care about you, stand with you, and want to support you in ways that help you sustain joy in your work. We have provided best-practice and highly respected resources here for provider well-being. May you continue to find purpose and fulfillment in your calling to this very sacred work of health care. Resources Standford Well MD A robust site of resources, courses, publications, self-assessments, research, innovation, conferences, and trainings. https://wellmd.stanford.edu/ National Academy of Medicine A compilation of key resources for improving clinician well-being. https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/ American Association of Physician Leadership (AAPL) Resources, courses, and tools for Physician Wellness, Physician Leadership, and more. https://www.physicianleaders.org/resources/wellness Coalition for Physician Wellness Resources, mobile app, research, podcasts, books and publications. https://www.forphysicianwellbeing.org/ Healthcare Burnout Symposium – February 2023 Annual conference that addresses the multiple facets of burnout crisis and how to increase the well-being of physicians, nurses and administrators. Visit website to learn more about conference agenda and how to earn continuing education credits. https://www.stophealthcareburnout.com/ American Medical Association Alliance (AMA) Steps Forward Program: Improving Physician Resilience Resources for physicians to enhance their resiliency and prevent burnout. Visit website to learn more about the AMA’s Steps Forward guide and module. Physicians might be able to earn continuing education credits by completing the training. https://amaalliance.org/physician-burnout/ American College of Physicians Online learning center with webinar and videos available on physician well-being and professional fulfillment. https://www.acponline.org/online-learning-center/physician-well-being-and-professional-fulfillment Los Angeles County Medical Association (LACMA) Interactive Wellness dashboard and resources for physicians. https://www.lacmainteractive.com/mdlifeline National Suicide Prevention Hotline The lifeline provides 24/7, free and confidential support, prevention and crisis resources for anyone in need and best practices for professionals in the United States. https://988lifeline.org/ You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Community Partners - Community Partner Network Meeting
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 firstname.lastname@example.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
Provider Manuals - General Information
EHP's contracted Providers understand how IEHP functions and understand the rules and regulations IEHP must comply with, as governed by the California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). The Delegate or Provider has the responsibility to ensure review, understanding, and attestation of the information contained in the Manual. Acknowledgement of Receipt (AOR) 2023 Providers: 2023 Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox 2023 Hospital & IPA AORs For more information regarding 2023 Manuals, click here.
P4P - Proposition 56 - GEMT - PHDP-EPP Program
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 email@example.com. 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.
Leadership Team - Jarrod McNaughton, MBA, FACHE
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.
Leadership Team - Keenan Freeman, MBA
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.
Leadership Team - Edward Juhn, MD, MBA, MPH
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.
Leadership Team - Michelle Rai, MS
2020. She oversees IEHP’s communications and marketing programs and guides the development of long-term communication and marketing strategies. In this role, Ms. Rai oversees the strategic execution of IEHP’s branding, advertising, media relations, internal communications, digital and social media initiatives to align with IEHP’s Mission, Vision and Values.
Leadership Team - Takashi Wada, MD, MPH
clinical strategic leadership for IEHP in partnership with the Chief Quality Officer through collaborative, accountable processes to improve the quality-of-care delivery and drive improved health outcomes for IEHP Members. He is responsible for the health services division, including utilization management, behavioral health and care management, pharmacy, community health and health education, population health, health services special initiatives and health equity.
Leadership Team - Susie White, MBA
ork sphere and was appointed Chief Operating Officer (COO) in July 2019. As COO, Susie is responsible for IEHP’s overall day-to-day operations. She is highly regarded for her commitment to driving IEHP’s team culture, serving the plan’s 1.6 million Members and advancing the plan’s Provider experience through the implementation of strategic initiatives that support the plan’s Mission, Vision and Core Values.
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 March 22, 2023 May 10, 2023 August 30, 2023 November 8, 2023 Time: 12pm - 2pm