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Special Programs - Total Fracture Care
ticipating Orthopedist for global fracture care without a prior authorization. This Program ensures that Members in need of fracture care by an Orthopedist, as determined by an Emergency Department Physician, Urgent Care Physician or Primary Care Provider, will receive timely access to care.
Policy Reference:
10 - Medical Care Standards
Total Fracture Care Providers
Arrowhead Orthopaedics
For more information and locations, please visit: https://www.arrowheadortho.com/
Newport Care Medical Group
For more information please call: (951) 363-5064
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
投保 IEHP DualChoice
HMO D-SNP) 計畫的資格。我們的 IEHP DualChoice 計畫可協助您獲得所需的護理,帶給您最佳健康。 以 0 美元獲得的給付福利包括: 就醫,如例行檢查和生病就醫 來自 IEHP DualChoice 處方集的處方藥 醫院護理,如急診室服務和急需服務等,目前有資格運用 Medi-Cal,而且 專科病例 加上額外福利,如: 視力照護:每兩年以 350 美元為限的隱形眼鏡與一般眼鏡(含鏡框與鏡片)費用 為承保的公用事業提供 40 美元的公用事業津貼。您必須符合該福利的資格。 誰有資格投保 IEHP DualChoice (HMO D-SNP)? IEHP DualChoice 同時適用 Medicare (A 與 B 部分) 與 Medi-Cal 會員。下列資訊說明哪些人符合 IEHP DualChoice (HMO D-SNP) 的資格。 適用族群: 強制投保 Medi-Cal 福利,包括長期服務與支援 (LTSS) 福利,以及 Medicare 福利。 若您符合下列條件,則您可以加入我們的計畫: 居住在我們的服務區域內(被監禁者即使實際位於該地理服務區域,也不被視為居住於該服務區域),以及 投保時年滿 21 歲,且 擁有 Medicare A 部分和 Medicare B 部分;且 目前符合獲得 Medi-Cal 的資格,且 您是全福利的雙重合格受益人,並且為您的 Medicare 福利投保 IEHP DualChoice,為您的 Medi-Cal 福利投保 Inland Empire Health Plan (IEHP)。這被稱為獨家一致投保 (Exclusively Aligned Enrollment),且 為美國公民或在美國合法居留 如需投保,請於太平洋標準時間每天上午 8 點至晚上 8 點致電 1-800-741-IEHP (4347) 聯繫 IEHP DualChoice Medicare 團隊,假日亦提供服務。TTY 使用者請致電 1-800-718-4347。 IEHP DualChoice 投保表單 IEHP DualChoice (HMO D-SNP) 是與 Medicare 簽約的 HMO 計畫。投保 IEHP DualChoice (HMO D-SNP) 取決於合約續訂。 此頁面資訊為截至 2022 年 10 月 1 日的最新資訊。 H8894_DSNP_23_3241532_M Pending Accepted
Plan Updates - Newsletters
Provider Staff Newsletter; keep you in the know about our newest programs, incentive opportunities, study results, and more.
Volume 34 - Summer 2022 (PDF)
Volume 33 - Fall 2021 (PDF)
Volume 32 - Spring 2021 (PDF)
Volume 31 - Fall 2020 (PDF)
Volume 30 - Fall 2019 (PDF)
Volume 34 - Winter 2022 (PDF)
Volume 33 - Spring 2021 (PDF)
Volume 32 - Winter 2021 (PDF)
Volume 30 - Winter 2020 (PDF)
Volume 29 - Spring 2019 (PDF)
Volume 28 - Winter 2018 (PDF)
Volume 27 - Summer 2018 (PDF)
To access past Newsletters, please contact the Provider Relations Team at (909) 890-2054.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Member Testimonials - Our Members
group of students from the Inland Empire. More than 30 recipient students grew up in the Inland Empire and more than 50% are first generation medical students and grew up in low-income households. Through the scholarship fund, aspiring healthcare professionals will be guided through the system and connected to the health plan’s provider network. This allows students to pursue successful careers in healthcare immediately after graduation to help support the region’s growing population.
Loma Linda University School of Medicine
Inland Empire Medical Community Service Awardees
Class of 2022
Ye Jin Jeon
Ye Jin's Why:
“I applied for the Inland Empire Medical Community Service Award because the goal and priority to expand access to care and healthcare provider options for the Southern California region aligns with my calling. As a child growing up in the San Bernardino County, I saw the economic disproportion within my own neighborhood, and this compelled me…God has led me pursue my medical career”
Class of 2024
Edwin Choque
Edwin's Why:
“Simply put, my heart lies in the Inland Empire. This community of individuals have fostered me and loved me since I was a child and all I can hope is to pay that love and care forward. . . . My dream is to be on the front lines as a representative for these individuals who frequently become marginalized…”
University of California, Riverside
Dean's Mission Recipients
Four Year Award
Elizabeth Celaya-Ojeda
Elizabeth's Why:
“I want to work particularly with the underserved in this area because I truly believe that being a physician is a privilege and with that there is a responsibility to be an advocate for those who are facing health disparities. I am particularly interested in providing care to underserved Native American and Hispanic communities. Not many healthcare providers are aware of the disparities these two communities face and I want to be an advocate for them, especially in the Inland Empire.”
Alfonso Parocua
Alfonso's Why:
“Growing up, my family lacked meaningful access to healthcare and relied on a local free clinic as our only means of interacting with a physician. Through my personal experience with the free clinic, I developed a passion for service to the underserved communities who lack meaningful access to basic healthcare amenities due to low socioeconomic status. I sought opportunities that would allow me to pay my gratitude forward by becoming part of the solution to healthcare disparities in Inland Southern California. Through my volunteer efforts in free clinics and other community involvement programs, I witnessed the passion and dedication that health care providers and volunteers in the area have towards the underserved community. This realization deepened my connection to Inland Southern California because I was reminded so much of the health care professionals that helped my family when they couldn't help themselves.”
Two Year Award
Cesar Fortuna
Cesar's Why:
“A San Bernardino native, I have had the opportunity to volunteer in my community as a Spanish language translator for free clinics. Most patients I have spoken with fell into the category of uninsured, underinsured, or undocumented. It became clear the extent of need in this region when I would translate to the providers that this was the first-time dozens of our patients had ever seen a medical professional; however, this wasn’t uncommon. To these patients and their stories, I thank them because they inspire me to pursue Emergency Medicine where I can become a valuable player in providing care, providing resources, or providing comfort.”
Lavinia Mitroi
Lavinia's Why:
“My goal of pursuing a career at the intersection of medicine and public health is driven by a desire to put patients and communities at the center of our health care system in the U.S. This desire was sparked most poignantly by my own experiences as an IEHP patient growing up in the Inland Empire. As I prepare for a future career as a pediatrician in this region, I hope to serve as an advocate for children and families, providing direct health services but also creating systems change.”
Armando Navarro
Armando's Why:
“The earliest memory of my grandfather is him telling me, “Mijo, tienes que aprender Español para ayudar tu comunidad, you have to learn how to speak Spanish to help your community”. These words were often repeated to me by my grandfather who lamented the fact that he only spoke Spanish. I witnessed the health disparities affecting my community; doctors who did not speak Spanish, parents who could not afford a trip to the doctors’ office, and a healthcare system that was not inclusive of my community’s culture. I have a duty to give back to a school, a community, that has given me so much.”
Christ Ordookhanian
Christ's Why:
“I see the medical profession through the lens of an individual who had lived through challenging times and witnessed how one individual provider can make such and impact when their heart is in the right place. My dedication to our underserved community stems from that of a lifelong mission I have set for myself which is to ensure I give back to a community that I am deeply associated with, they are my founding roots in the United States, and I vow to be at the forefront of the next generation of physicians that care and give the underserved hope.”
University of California, Riverside
Dean's Mission Recipients
Daphne Du
Daphne's Why:
“I spent most of my life in underprivileged areas and saw firsthand how difficult healthcare access could be through inadequate financial resources, transportation, or translation services. Thanks to this investment in my studies, there is less stress in my life. I can focus on my studies and eventually give back to the community by becoming a physician who will advocate for patients without meaningful access to health care.”
Judith Gonzales
Judith's Why:
“As a first-generation college student, there have always been many barriers in my path to higher education. I am the eldest daughter of an immigrant family, and it is truly an honor to be able to reach this point in my education and in my career, and to give back to my parents who have sacrificed so much for me and my sisters. Growing up in an underserved community showed me the long-lasting impacts of health inequities and strengthened my resolve to pursue a career in medicine. Working in the Inland Empire, I hope to not only address, but actively work towards combating the health inequity present in our communities.”
Jordan Hough
Jordan's Why:
“Despite disadvantages encountered when living in a low-income community, I am grateful for the privilege I had in meeting physicians dedicated to their practice and willing to share that love through mentorship. These individuals have served as exemplary medical professionals and have encouraged me to follow in their footsteps. As a future physician, I aspire to empathetically care for patients by allowing my past experiences to enhance my understanding of their needs. I also plan to incorporate teaching into patient care by presenting opportunities for students to shadow and be mentored for a career in medicine.”
Diana Martinez
Diana's Why:
“I am the daughter of Mexican Immigrants and grew up in Compton, California where I unfortunately was quickly desensitized to violence and was able to tell the difference between a firework and a gun shot. My mother had to travel a significant distance to ensure we had adequate healthcare. Despite these conditions, my parents always stressed education and did their best to give me what I needed. These life circumstances ignited my passion to serve those in disadvantaged communities, which I interacted with throughout my educational career. The Inland Empire Health Program Scholarship means I can achieve my dream –by practicing medicine in a community that deserves adequate, equitable, and accessible healthcare. I will serve as a bilingual physician in the Inland Empire that can serve families like my own and many more.”
Special Programs - Alcohol & Drug (SABIRT)
ant to the Department of Health Care Services (DHCS) APL 21-014 (PDF), “Alcohol and Drug SABIRT,” IEHP has updated its requirements for alcohol and substance use screening in the primary care setting. Helpful resources:
Correspondence - June 2022 - Alcohol and Drug SABIRT
Training Guide (PDF)
Screening Tools
Alcohol Use Disorders Identification Test (AUDIT-C)
Brief Addiction Monitor (BAM) (PDF)
Cut Down-Annoyed-Guilty-Eye-Opener Adapted to Include Drugs (CAGE-AID) (PDF)
Tobacco Alcohol, Prescription Medications and other Substances (TAPS) (PDF)
National Institute on Drug Abuse (NIDA) Quick Screen for Adults (PDF)
Drug Abuse Screening Test (DAST-10) (PDF)
Parents, Partner, Past, and Present (4Ps) for pregnant women and adolescents (PDF)
Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents (PDF)
Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population (PDF)
Assessment Tools
Alcohol Use Disorders Identification Test (AUDIT) (PDF)
Brief Addiction Monitor (BAM) (PDF)
NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST) (PDF)
Drug Abuse Screening Test (DAST-20) (PDF)
Pamphlets
Riverside Brochure (English) (PDF)
Riverside Brochure (Spanish) (PDF)
San Bernardino Brochure (English) (PDF)
San Bernardino Brochure (Spanish) (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.
Join Our Network - IPA
p
1668 S. Garfield 2nd Fl.
Alhambra, CA 91801
(877) 282-8272
(626) 943-6329
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
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
Join Our Network - Hospitals
CA 92324
(909) 580-1000
(909) 580-6308
Barstow Community Hospital
820 E Mountain View
Barstow, CA 92311
(760) 256-1761
(760) 957-3397
Bear Valley Community Healthcare District
41870 Garstin Drive
Big Bear Lake, CA 92315
(909) 866-6501
(909) 878-8282
Chino Valley Medical Center
5451 Walnut Ave.
Chino, CA 91710
(909) 464-8600
(909) 464-8882
Colorado River Medical Center
1401 Baily Ave.
Needles, Ca. 92363
(909) 326-7100
(909) 326-7292
Community Hospital of San Bernardino
1805 Medical Center Dr #201
San Bernardino, CA 92411
(909) 887-6333
(909) 806-1044
Corona Regional Medical Center
800 S Main St.
Corona, CA 92882
(951) 737-4343
(951) 736-6310
Desert Regional Medical Center
1150 N Indian Canyon Dr.
Palm Springs, CA 92262
(760) 323-6511
(760) 323-6330
Desert Valley Hospital
16850 Bear Valley Rd.
Victorville, CA 92395
(760) 241-8000
(760) 951-2034
Eisenhower Medical Center
39800 Bob Hope Dr.
Rancho Mirage, CA 92270
(760) 340-3911
(760) 773-1532
Hemet Global Medical Center
1117 E Devonshire Ave.
Hemet, CA 92543
(951) 652-2811
(951) 765-4745
Hi-Desert Medical Center
6601 White Feather Rd.
Joshua Tree, CA 92252
(760) 366-3711
(760) 365-9309
Inland Valley Regional Medical Center
36485 Inland Valley Dr.,
Wildomar, CA 92595
(951) 677-1111
(951) 698-7721
John F. Kennedy Memorial Hospital
47111 Monroe St.
Indio, CA 92201
(760) 347-6191
(760) 775-8014
Loma Linda University Children's Hospital
11234 Anderson St.
Loma Linda, CA 92354
(909) 558-8000
(909) 558-3278
Loma Linda University Medical Center
11234 Anderson St.
Loma Linda, CA 92354
(909) 651-1702
(909) 478-3202
Loma Linda University Medical Center - Murrieta
28062 Baxter Rd.
Murrieta, CA 92563
(951) 290-4000
(951) 290-4092
Menifee Global Medical Center
28400 McCall Blvd.
Sun City, CA 92585
(951) 679-8888
(951) 766-6470
Montclair Hospital Medical Center
5000 San Bernardino St.
Montclair, CA 91763
(909) 625-5411
(909) 626-4777
Mountains Community Hospital
29101 Hospital Rd.
Lake Arrowhead, CA 92352
(909) 336-3651
(909) 336-4730
Palo Verde Hospital
250 N 1st St.
Blythe, Ca 92225
(760) 922-4115
(760) 921-5263
Parkview Community Hospital Medical Center
3865 Jackson St.
Riverside, CA 92503
(951) 688-2211
(951) 352-5363
Pomona Valley Hospital Medical Center
1798 N. Garey Ave.
Pomona, CA 91767
(909) 865-9500
(909) 865-2104
Rancho Springs Medical Center
25500 Medical Center Dr.
Murrieta, CA 92562
(951) 696-6000
(619) 627-5949
Redlands Community Hospital
350 Terracina Blvd.
Redlands, CA 92373
(909) 335-5500
(909) 335-6497
Riverside Community Hospital
4445 Magnolia Ave.
Riverside, CA 92501
(951) 788-3000
(951) 788-3201
Riverside University Health Care System
26520 Cactus Ave.
Moreno Valley, CA 92555
(951) 486-4000
(951) 486-4475
San Antonio Regional Hospital
999 San Bernardino Rd.
Upland, CA 91786
(909) 985-2811
(909) 920-6357
San Gorgonio Memorial Hospital
600 N Highland Springs Ave.,
Banning, CA 92220
(951) 845-1121
(951) 845-2836
St. Bernardine Medical Center
2101 N Waterman Ave.,
San Bernardino, CA 92404
(909) 883-8711
(909) 881-4337
St. Mary Medical Center
18300 US Highway 18
Apple Valley, CA 92307-2206
(760) 242-2311
(760) 946-8714
Temecula Valley Hospital
31700 Temecula Pkwy
Temecula, CA 92592
(951) 331-2200
(951) 331-2211
Victor Valley Global Medical Center
15248 Eleventh St.
Victorville, CA 92395
(760) 245-8691
(760) 245-6996
Join Our Network - Ancillary
ly contracted provider.
PLEASE NOTE, IEHP is currently not accepting new:
DME
Hospice
Specialty Pharmacy
Clinical Laboratories
Please check monthly for updates on Network Availability.
Prior to extending a contract, we must receive the following documents:
1. Ancillary Provider Network Participation Request Form (PDF)
2. W-9 Form
A current Taxpayer Identification Number and Certification Form
3. Liability Insurance Certificate
Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrence.
Three Million Dollars ($3,000,000) aggregate per year for professional liability.
4. Ownership Information (PDF)
Name, Title and Percentage of Ownership
5. Provider Accreditation Certificate
6. CMS/DHCS Passing Site Survey (Approval Letter)
Required for each facility
7. California State License (if applicable)
Required for each facility
8. Urgent Care Minimum Qualifications (if applicable)
All Ages (PDF)
Pediatrics (PDF)
9. Medi-Cal Number
Ancillary Providers need to successfully enroll in the State's Medi-Cal Program
10. Provider Acknowledgment of Receipt (AOR) (PDF)
IEHP is required by State and Federal regulators to maintain an AOR form on file for our Providers signifying your receipt and review of the Policy & Procedure manuals, including annual updates
11. Electronic Remittance Advice (ERA) Form (PDF)
Ancillary Providers must complete the ERA form
Contracts Maintenance Request Form can be found here (PDF).
Any delay in receiving the above stated documents will affect the effective date of the contract that will be mailed to you.
The contract collateral and other supporting contract documents should be e-mailed to contract@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.
Join Our Network - Behavioral Health
l Health Forms
Behavioral Health
As a local Health Plan, Inland Empire Health Plan (IEHP) is committed to improving behavioral health services for our Members by developing direct relationships with select clinicians.
IEHP now has over 1,000,000 Members. Behavioral Health Clinicians are viewed as "Specialists" that are partners in improving the health status of our Members. IEHP Behavioral Health is an integrated essential partner with primary medical care.
IEHP’s Direct Behavioral Health Program will offer our Behavioral Health Specialists:
Streamlined Authorization & Claims Submission - via our fast and secure website.
Competitive Reimbursement Rates - based on current Medicare rates.
Speedy Payments - our track record is payment in less than 3 weeks (in most cases).
Personal, Friendly Service - to ensure a successful and long-lasting working relationship.
IEHP is committed to develop direct partnerships with Psychiatrists, Psychologists, LCSW's, LMFT's, Psychiatric Nurse Practitioners, Physician Assistants, and most recently, Licensed Professional Clinical Counselors (LPCC) who have met the couples and family qualifications. LPCCs without this qualification will not be considered eligible to join IEHP's Behavioral Health Network. For any questions or concerns, please email Contract@iehp.org.
Requirements for this certification can be found here: https://www.bbs.ca.gov/pdf/publications/lpcc_couple-fam_courses.pdf
In compliance with APL 17-019 (a DHCS regulation), IEHP now requires Behavioral Health Providers to begin the process of enrolling with Medi-Cal prior to contracting with IEHP.
To ensure timely processing of your application, IEHP will accept your application to contract upon receipt of verification of Medi-Cal enrollment submission.
Prospective Providers:
QASP
PLEASE NOTE, IEHP is now accepting new QASP Providers in all services areas.
Behavioral Health
Behavioral Health Provider Letter and Application (PDF)
Why You Should Contract with IEHP Directly for Behavioral Health (PDF)
How IEHP Keeps You Informed and Drive Business to Your Practice (PDF)
Medi-Cal Number (Physicians should be enrolled in the State's Medi-Cal Program)
Existing Providers:
Contracts Maintenance Request Form (PDF)
W-9 Form (PDF) (Remittance advice address change)
Medi-Cal Number (Physicians should be enrolled in the State's Medi-Cal Program)
Frequently Asked Questions (FAQs)
What is IEHP?
How do I contract with IEHP?
What are IEHP's compensation rates?
What are IEHP’s minimum requirements to be considered for your BH Network?
What if I have additional information about my practice, specialties or experience that is not covered on the survey; where can I send this information?
When will I hear back from IEHP after I send my contract in?
What services does IEHP offer online?
What are the benefits and limitations for Medicare DualChoice Members?
I am a Behavioral Health Treatment Provider for one or more of the following services, how do I contract with IEHP? (Services for Individuals (0-21) with Autism, Developmental Disabilities, or Specialized Behavioral needs; utilizing Applied Behavior Analysis and Behavior Modification treatment modalities)
What is IEHP?
IEHP stands for Inland Empire Health Plan. IEHP is a not-for-profit health plan that serves over 1,000,000 Members in public-sponsored health coverage programs including Medi-Cal and Medicare Special Needs Plan.
How do I contract with IEHP?
The first step is to fill out the Behavioral Health Provider Letter and Application (PDF) and email Contract@iehp.org. We will contact you directly once we have evaluated our Member’s needs and are ready to proceed with contracting.
What are IEHP compensation Rates?
Reimbursement rates for Behavioral Health Services are based on Medicare rates.
What are IEHP’s minimum requirements to be considered for your BH Network?
A valid California License (LCSW, LMFT, LPCC, Psychologist, Psychiatrist, Nurse Practitioner)
$1 million to $3 million Malpractice Insurance
Must be enrolled with Medi-Cal
Satisfy all IEHP’s standard credentialing requirements
What if I have additional information about my practice, specialties or experience that is not covered on the survey; where can I send this information?
You can send your information to:
Inland Empire Health Plan
Attention: Provider Relations
P.O. Box 1800
Rancho Cucamonga CA 91729-1800
When will I hear back from IEHP after I send my contract in?
Over the next two to three months we will be gathering information and determining our needs and as soon as we have determined what Providers we will need we will send out draft contracts with rate sheets for review.
What services does IEHP offer online?
Member Eligibility Verification
Claims Submission Services
Claims Status
Authorization Status
Medication Search
Pharmaceutical Services
Information Resources
Provider Manuals; Benefit Manuals; EDI manuals
What are the benefits and limitations for Medicare DualChoice Members?
Click here.
I am a Behavioral Health Treatment Provider for one or more of the following services, how do I contract with IEHP? (Services for Individuals (0-21) with Autism, Developmental Disabilities, or Specialized Behavioral needs; utilizing Applied Behavior Analysis and Behavior Modification treatment modalities)
The first step is to fill out the Behavioral Health Provider Letter and Application (PDF) and email Contract@iehp.org. We will contact you directly once we have evaluated our Member’s needs and are ready to proceed with contracting.
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 - POLST Registry
fornia Physician Orders for Life Sustaining Treatment (POLST) Registry (CPR) to connect a digital POLST network throughout the Inland Empire Healthcare System which includes independent physicians, hospitals, skilled nursing facilities, and the Health Information Exchange (HIE). The goal of this initiative is to provide a more effective means of documenting, communicating, and ensuring Member desired Treatment at the end of life is being honored.
By clicking on these links, you will be leaving the IEHP website.
To login, visit Working Toward a Statewide POLST Registry in California | POLST (capolst.org)
To sign up, simply go to POLST for Healthcare Providers | POLST (capolst.org)
CPR Correspondence (PDF)
CPR FAQ (PDF)
For any questions, please contact Care Directives at (888) 621-4383 or email support@caredirectives.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.
Provider Resources - Additional Resources & Tools
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After Hours Care
After Hours Phone Numbers
IEHP Access Standards
IEHP Direct Adult Hospitalists
LabCorp Locations
Urgent Care Clinics
After Hours Care
IEHP Providers can direct Members to access care after hours. After hour care includes the 24-Hour Nurse Advice Line, DocOnline and Urgent Care Clinics.
Fever? Pain? Cold? Call our 24-Hour Nurse Advice Line
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Your Members can call the IEHP 24-Hour Nurse Advice Line for medical advice anytime, day or night: 1-888-244-IEHP (4347)
DocOnline, an extension to the Nurse Advice Line, allows Members to speak with a board-certified Physician for advice after hours using telephonic and/or video devices. DocOnline Physicians will triage, assess, and provide diagnoses for minor acute conditions. Physicians may also give treatment advice, refill select prescriptions and refer Members for in-person care.
DocOnline FAQs (PDF)
Prescription Medication Refill List (PDF)
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After Hours Phone Numbers for Coverage Determination and Expedited Appeals
IEHP DualChoice (HMO D-SNP) Members
The following numbers are to be used for after hour requests:
Coverage Determinations:
Phone: (888) 860-1297
Expedited Appeals:
Phone: (866) 223-4347
Fax: (909) 890-5748
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IEHP Access Standards
On an annual basis, IEHP conducts the Appointment Availability Access Study. All Members must receive access to all covered services without regard to sex, race, color, religion, ancestry, national origin, creed, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, sexual orientation, or identification with any other persons or groups defined in Penal Code Section 422.56, except as needed to provide equal access to Limited English Proficiency (LEP) Members or Members with disabilities, or as medically indicated.
Appointment Standards for All Provider Types (PDF)| Last Revised: 12/12/2022
Appointment Standards for Behavioral Health (PDF)| Last Revised: 01/11/2023
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IEHP Direct Adult Hospitalists
Direct Adult Hospitalist (PDF) | Last Revised: 02/27/2023
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LabCorp Locations
A listing of LabCorp Patient Service Centers around the Inland Empire can be found below:
LabCorp Patient Service Centers (PDF)
LabCorp Patient Service Centers at Walgreens (PDF)
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Urgent Care Clinics
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Any of your IEHP Members needing medical attention may visit an Urgent Care Clinic after regular business office hours and on weekends. A listing of all Urgent Care Clinics is found on the IEHP Doctor Search.
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You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - IEHP DualChoice - Model of Care
als who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan).
IEHP has identified the most vulnerable as the following:
Age 21-70
Identified as High and Rising Risk
Diagnosed with Cardiovascular Disease AND/OR Diabetes
RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services.
IEHP will identify the most vulnerable members assigned to IPAs
IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals.
Examples of Specially Tailored Services for the Most Vulnerable Population
Remote Patient Monitoring
Medically Tailored Meals and Other Community Supports
Nutrition Education
Pharmacy Services (medication reconciliation and other programs)
Long-Term Services and Supports (LTSS)
Telehealth Behavioral Health Services
Transportation
More frequent care management contact
IEHP DualChoice (HMO D-SNP) Model of Care Training
The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members:
Interdisciplinary Care Team (ICT) Fact Sheet (PDF)
IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF)
IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)
*We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Pharmacy
gram, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information.
If you have any questions regarding services provided by the Pharmaceutical Services Department, please feel free to contact the IEHP Pharmacy Department at (909) 890-2049.
Pharmaceutical Services
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)
Provider Dispute Resolution Process
For more information about the Provider dispute resolution process for contracted and non-contracted Providers, click here
Other Health Coverage (OHC)
Coordination of Benefits with Other Health Coverage (OHC) (PDF)
Frequently Asked Questions (FAQs) - OHC (PDF)
Provider Resources - Non-Contracted Providers
s for Contracted and Non-Contracted Providers
Emergency and Post-Stabilization Care for IEHP Members
IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers
Provider Dispute Resolution Process for Contracted and Non-Contracted Providers
Definition of a Provider Dispute
A provider dispute is a written notice from the provider to Inland Empire Health Plan (IEHP) that:
Challenges, appeals, or appeals, or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted, or contested
Challenges a request for reimbursement for an overpayment of a claim
Seeks resolution of a billing determination or other contractual dispute
What is not Considered to be a Provider Dispute
Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from primary carrier, or itemized bills are not considered Provider Disputes
Corrected Claims
Pre-Service Authorization Denials
Provider Dispute Time Frame
IEHP accepts disputes from providers if they are submitted within 365 days of receipt of IEHPs decision (for example, IEHPs Remittance Advice (RA) indicating a claim was denied or adjusted).
Submission of Provider Disputes
When submitting a provider dispute, a provider should use a Provider Dispute Resolution Request form. If the dispute is for multiple, substantially similar claims, complete the spreadsheet on page 2 of the Provider Dispute Resolution Request Form
All Provider Disputes and supporting information must be submitted to:
IEHP Claims Appeal Resolution Unit
PO BOX 4319
Rancho Cucamonga, CA 91729-4349
Acknowledgement of Provider Dispute
IEHP acknowledges receipt of each provider dispute, regardless of whether the dispute is complete, within 15 business days of receipt.
Resolution Timeframe
IEHP resolves each provider dispute within 45 business days following receipt of the dispute, and provides the provider with a written determination stating the reasons for determination.
PDR Determination Resulting in Additional Payment
If IEHP determines to pay additional monies based on information originally provided and/or available at the time the claim was first presented to IEHP for adjudication, or a result of a processing error IEHP will automatically include the appropriate interest amount if payment is not issued within required regulatory timeframes.
Non-Contracted Provider Disputes Resolution Process for IEHP DualChoice (HMO D-SNP)
A non-contracted provider, on his or her own behalf, is permitted to file a standard appeal for a denied claim only if the non-contracted provider completes a waiver of liability statement, which provides that the non-contracted provider will not bill IEHP DualChoice (HMO D-SNP) Plan Members.
Who to Call with Questions on IEHPs PDR Process
Contracted providers may visit our online secure provider portal at www.iehp.org for more information. Providers may also call the IEHP Provider Call Center at (909) 890-2054 or (866) 223-4347 Monday-Friday, 8:00 am to 5pm PST.
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Emergency and Post-Stabilization Care for IEHP Members
Triage and Advice Systems
IEHP provides Members triage, screening, and advice services by telephone 24 hours a day, 7 days a week through its Nurse Advice Line (NAL). By calling the NAL, Members receive assistance with access to urgent or emergency services from an on-call physician, or licensed triage personnel. IEHP Members can reach this 24/7 Nurse Advice Line at (888)-244-IEHP (4347) or 711 (TTY).
Post-Stabilization Care
IEHP requires contracted and non-contracted hospitals to obtain prior authorization for post-stabilization care for Members (patients). IEHP requests the patient’s diagnosis as indicated by the treating physician or surgeon and any other information reasonably necessary for the Plan to decide on whether to authorize post-stabilization care or to assume management of the patient’s care by prompt transfer to another facility. The hospital should request prior authorization from IEHP’s Utilization Management (UM) Department by:
Phone at (866) 649-6327; or
Fax at (909) 477-8553 to send clinical notes for medical necessity review.
IEHP makes every effort to respond to requests for necessary post-stabilization care within thirty (30) minutes of receipt. The services are considered approved if IEHP does not respond within this timeframe. All subsequent hospital day are subject to review for medical necessity.
IEHP will inform the provider of the Plan’s decision and will coordinate the transfer of the Member if IEHP denies the request for authorization of post-stabilization care and elects to transfer the Member to another health care provider.
Non-Emergency Services
If a Member presents at the emergency department for non-emergency services, please refer the Member to their IEHP Member Handbook, section 3 (How to Get Care), which outlines the process for obtaining a referral.
Claims Reimbursement
Complete facility claims for authorized health care services must be sent to:
Inland Empire Health Plan
Attn: Claims Department – IEHP Direct
PO BOX 4349
Rancho Cucamonga, CA 91729-4349
Complete professional claims for authorized health care services must be sent to:
For IEHP-Direct Members, please send to address above.
For IEHP Members assigned to an IPA, please click for here for more information on how to send to the appropriate IPA.
Billing IEHP Members
Providers under the Medi-Cal program must not submit claims to, demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from other persons on behalf of the beneficiary, for any service included in the Medi-Cal program’s scope of benefits in addition to a claim submitted to the Medi-Cal program for that service.
IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers
The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS), and National Committee for Quality Assurance (NCQA) requirement that out-of-network providers routinely seen by IEHP DualChoice (HMO D-SNP) Members, receive training on IEHPs Model of Care for our D-SNP Members:
IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF)
IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)
*We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer
2023 IEHP DualChoice (HMO D-SNP) Model of Care eAOR
2023 IEHP DualChoice (HMO D-SNP) Model of Care Non-Contracted Provider AOR (PDF)
Report an Issue
To report any issues with this system or process or for any questions, please send an email to DGHospitalRelationsServiceTeam@iehp.org
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You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
P4P - Proposition 56 - GEMT - Prop 56 - Value Based Payment
OS June 30, 2022, payments will run out through June 2023.
The Proposition 56 VBP Program provided direct payments incentivizing Providers to meet specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas were behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website.
Value Based Payments Program Guide
Value Based Payments (VBP) Program Guide (PDF) - Published: January 01, 2022
Value Based Payments Dispute Forms
Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: January 19, 2022
Value Based Payments Program - Encounter Dispute Request (PDF) Published: January 19, 2022
Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org
At-Risk Condition Codes
The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details.
At-Risk Condition Codes (PDF) Published: March 25, 2020
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
COVID-19 - 檢測地點
檢測以治療」站點完成。
如果您的醫療狀況使您更有可能因 COVID-19 加重病情,您可能有資格接受治療。 成人和年滿 12 歲的兒童可以接受治療,但必須在出現症狀後 5 天內盡快開始治療。
按一下此處以進一步瞭解 COVID-19「檢測以治療」計畫的相關資訊。
免費的居家 COVID-19 檢測
美國境內的每個家庭都有資格訂購一個免費的 COVID-19 檢測試劑盒,其中包括四個居家檢測試劑。這些檢測完全免費。按一下此處以訂購由美國郵政管理局 (United States Postal Service, USPS) 提供的免費居家檢測。
自 2022 年 2 月 1 日起,Medi-Cal 會員可接受 Medi-Cal 網絡內藥局提供的居家 COVID-19 檢測服務。加州衛生保健服務局 (California Department of Health Care Services, DHCS) 每月可為每名會員報銷最多 8 份檢測試劑盒。如需瞭解哪些檢測試劑盒在承保範圍內,或者如果您需要處方相關協助,請諮詢您的醫生或您的藥劑師。
如果 Medi-Cal 會員在 2021 年 3 月 11 日至 2022 年 1 月 31 日期間購買居家檢測試劑盒,則可以透過此處列出的程序由 DHCS 報銷費用(須提供收據)。
San Bernardino 郡支援的檢測點將為在 San Bernardino 郡生活、工作或上學的人士提供免費的居家 COVID-19 檢測試劑盒(需要提供居住或就業證明)。按一下此處以尋找郡級協助檢測點的清單。
檢測
IEHP 會承保提供者安排進行的檢測,包括 PCR、快速檢測、居家檢測等。如果您的醫生為您安排檢測,IEHP 將承擔檢測費用。您的提供者需要為這些檢測直接向 IEHP 請款。
如會員選擇支付並非由提供者要求進行的 COVID 檢測,IEHP 不會予以報銷。
如需更多有關 Riverside 郡 COVID-19 檢測點的資訊,請造訪 Riverside 郡公共衛生處 網站。
如需更多有關 San Bernardino 郡 COVID-19 檢測點的資訊,請造訪 San Bernardino 郡 COVID-19 檢測點。
最新消息 - IEHP 25 週年慶「做正確的事」
並僱用近 2,500 名團隊成員,繼續在策略道路上前行以紀念此重要里程碑。 「在過去 25 年裡,我們非常高興能讓本地區數百萬人獲得全人醫療保健服務,」IEHP 執行長 Jarrod McNaughton 說道。「隨著 CalAIM 等大型計畫的實施和 COVID-19 疫情的持續,我們必須繼續滿足會員、提供者和團隊成員的需求,以便有效地合作,為本地區居民提供最佳照護和健康活力。」 IEHP 自 1996 年開始營運,擁有超過 60,000 名 Medi-Cal 會員,並於 1998 年啟動健康家庭計畫 (Healthy Families Program),積極為不符合 Medi-Cal 資格之工薪家庭中的未投保兒童提供保險。截至 2000 年,IEHP 已成為加州第一批獲得 NCQA「值得推薦」認證的純 Medi-Cal 健康計畫,並在美國最大的 Medicaid 計畫中排名第九。 隨著多項支持兒童(健康兒童計畫 (Healthy Kids))、老年人(Medicaid)、殘障人士(Medicare 雙選計畫 (Medicare DualChoice))和特定健康狀況(如糖尿病和氣喘)人群計畫的建立,IEHP 能夠支持因《平價照護法案》(Affordable Care Act) 而增加的符合醫療服務資格的內陸帝國居民,2015 年健康計畫的會員數增加至 100 萬人。 最近,此健康計畫被評為加州老齡化總體計畫 (Master Plan for Aging) 的典範,並為本州的多年轉型計畫提供多個創意,以解決影響本州 Medi-Cal 人口 (CalAIM) 的許多複雜挑戰。作為典範的計畫包括圍繞健康和住房創新主題的健康計畫,例如 IEHP 的 住房計畫 (Housing Initiative) 和健康之家計畫 (Health Home Program)。 除了支持 CalAIM 等轉型計畫外,IEHP 也致力尋求永續性解決方案,以提高本地區居民的正向健康成果。「雖然我們慶祝在本地區的優異表現,但我們作為一個社區型健康計畫的工作還有一大段路要走,」McNaughton 說道。 「在內陸帝國建立和加強提供者網路以抵消持續的提供者短缺問題,並與我們的合作夥伴共同建立電子病歷系統 (Electronic Medical Record System) 以更好地照顧會員,只是我們努力進行的兩項優先事項,」McNaughton 補充說道。「我們的口號是始終為會員『做正確的事』,我們的使命是治癒和激勵人道精神,這將引導我們的思想、決策,而且最重要的是,引導我們透過這些項目和 IEHP 在未來數月和數年採取行動。」
最新消息 - 社區植物園以食品、魚類和友誼伴您成長
lan (IEHP) 與社區合作夥伴密切合作,為這些植物園提供支持,其中包括與音樂公司 Music Changing Lives (MCL) 首席執行官 Josiah Bruny 愉快的合作,大家攜手為聖貝納迪諾打造出一個全新的社區植物園。 這片土地位於聖貝納迪諾 Electric Avenue 與 North 40th Street 的拐角處,曾是該市最大的垃圾場之一,現已被改造成 MCL 的城市植物園。除了解決食品無保障的問題外,植物園還旨在提供一個安全的空間,讓鄰居們可以聚在一起學習、鍛煉、就餐、探究、放鬆和玩樂。 每月的第四個星期日都會舉辦「靈魂星期天」(Soulful Sunday) 活動,邀請當地居民參觀植物園,參加園藝工作坊和各種志願者活動,同時享受各種美食與音樂等。如需查看有關 Soulful Sunday 的資訊,請造訪 MCL 的 Facebook 網頁。 「這項計畫的亮點在於它是完全由社區領導,」Bruny 說。「只要我們所有人齊心協力,便能為該地區及最需要幫助的人帶來更多的關愛。我們期盼能持續合作,讓 Inland Empire 成為對所有人來說都更美好的家園。」 除了提供贊助外,IEHP 還透過公司的團隊成員「樂於助人」 (Helping Hearts) 計畫和健康教育 (Health Education) 團隊召集志願者為植物園提供支持。志願者們與計畫負責人一起除草、植樹、鋪地膜、建造園圃以及灌溉農作物。 「有了完美的伙伴關係、同情心、治愈與振奮人類精神的動力,這些植物園會不斷蓬勃發展,並讓我們的鄰居體驗到各種健康,」IEHP 社區健康高級主任 Cesar Armendariz 說。「我們非常感激 Music Changing Lives 對 Inland Empire 以及這裡的居民們的熱愛,也十分期待能繼續攜手種植和建立更多的植物園,從而打造一個更健康的社區。」 該健康計畫還向「Jardín Comunitario de la Salud」(西班牙語意思為「健康社區植物園」)提供贊助,幫助支持聖貝納迪諾 Loma Linda University Health SACHS 診所的大型魚菜共生植物園。 這個植物園是 Inland Empire 的第一個此類植物園,它養殖了大量魚類,這些魚類生活在一處,可以滋養園圃。另外,這個植物園還在努力種植出豐收好且可供社區享用的食品。 植物園遍佈在庫卡蒙格牧場、安大略、朱魯帕、佩里斯與聖貝納迪諾。如需瞭解當地社區植物園的更多資訊,請造訪:riversidefoods.org。