Correspondences
Please see the following PDF links below.You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here
Coronavirus (COVID-19) Advisory
Last Updated: April 01, 2020
The Centers for Disease Control and Prevention (CDC) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in almost 70 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
IEHP will continually update you on the latest recommendations, news, and resources on COVID-19 as it becomes available.
Provider Relations
If you have any questions, please do not hesitate to contact the IEHP Provider Relations Team at (909) 890-2054 or email at providerservices@iehp.org
By clicking on the links below, you will be leaving the IEHP website.
COVID-19 Webinars
- Strategies for Implementing Telehealth in Your Practice on Friday March 27, 2020 at 7:00 AM and Monday, March 30, 2020 at 7:00 AM (PDF) - March 26, 2020
- COVID-19 Related Paid Leave for Workers & Tax Credits for Employers on Thursday, March 26, 2020 at 6:00 PM (PDF) - March 23, 2020
- COVID-19 Strategies for Implementing Telehealth in Your Practice on Wednesday, March 25, 2020 at 7:00 AM, 12:30 PM, and 7:00 PM (PDF) - March 23, 2020
Postponing/Rescheduling Routine/Non-Urgent/Elective Procedures
IEHP understands at this time that Providers will be rescheduling and postponing non-urgent visits and elective procedures. We encourage Providers to exercise their best clinical judgment to minimize in-person visits that are not of a critical or emergent nature.
Healthcare facilities and clinicians should prioritize urgent and emergency visits and procedures now and for the coming several weeks. The following actions can preserve staff, personal protective equipment, and patient care supplies; ensure staff and patient safety; and expand available hospital capacity during the COVID-19 pandemic:
- Delay all elective ambulatory provider visits
- Reschedule elective and non-urgent admissions
- Delay inpatient and outpatient elective surgical and procedural cases
- Postpone routine dental and eyecare visits
Routine Childhood Immunizations during COVID-19 Pandemic (PDF) - March 31, 2020
MEMORANDUM: Important Covid-19 Update for Referring Providers to RUHS Specialty Clinics (PDF) - March 31, 2020
California Optometric Association guidance to Optometrists re: Postponing Routine Eye Care Visits - April 01, 2020
Request for Provider Office Supplies (Masks, Disinfectants, Gloves, etc.)
IEHP has received numerous calls from Providers asking for supplies including disinfectant, gloves, masks, etc. Unfortunately, IEHP is not a supplier or provider of these materials and is unable to provide these resources to offices. Please continue to contact the vendors you normally utilize for these supplies or seek out additional resources as across the market, supplies are running low due to the high demand.
Screening Questions for Providers to ask Patients calling in regarding Suspected COVID-19
Here is a list of questions Providers should ask their patients when screening for potential COVID-19 exposure (source: History that needs to be presented to Department of Public Health to evaluate a case – Riverside University Health System – Public Health communication.)
- What are your symptoms (fever, cough, other lower respiratory symptoms)?
- What was the date the symptoms began?
- Have you traveled and what were the specific cities or regions visited and when?
- Have you been exposed to anyone who may have COVID-19 with focus on household contacts?
Please continue to refer to the Centers for Diease Control and Prevention (CDC), San Bernardino County's Public Health and Riverside County Public Health System for updated guidance as this situation evolves.
Telehealth
IEHP is strongly encouraging the utilization of telehealth for visits that can be conducted over the phone or via other audiovisual telecommunications. IEHP has published a telehealth FAQ which is available here: UPDATED- Telehealth Services Due to Limiting Exposure to COVID-19 (PDF)- March 31, 2020
- ESRD Provider Telehealth and Telemedicine Tool Kit (PDF) - March 27, 2020
- General Provider Telehealth and Telemedicine Tool Kit (PDF) - March 27, 2020
- UPDATED- Telehealth Services Due to Limiting Exposure to COVID-19 - March 25, 2020
- COVID-19 Strategies for Implementing Telehealth in Your Practice on Wednesday, March 25, 2020 at 7:00 AM, 12:30 PM, and 7:00 PM (PDF) - March 23, 2020
- DHCS - Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19) (PDF) - March 18, 2020
- Telehealth Services Due to Limiting Exposure to COVID-19 - March 12, 2020
Remember:
- IEHP expects that Providers will offer telehealth services and support to their Members during their published business hours.
- Existing authorizations are valid and do not need to be changed even if services are being provided via telehealth
- You can request a POS 02 on your authorization however if you do not, you can still utilize the authorization for telehealth services even if a different POS was approved. When billing the claim for the service, you will utilize a POS 02.
- ONLY Services that are deemed clinically appropriate to provide via telehealth should be provided via telehealth. If there are treatments, exams, procedures or other services that cannot be provided via telehealth, those are not eligible to be provided via telehealth.
UPDATED: Rates for Services provided through Telehealth
Per DHCS’s Emergency Telehealth Guidance to Medi-Cal Managed Care Health Plans published on March 18, 2020, services are to be paid at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery. This direction pertains specifically and only to reimbursement for services provided to Medi-Cal Members.
Per CMS’s Medicare Telehealth FAQs published on March 17, 2020, the following Q and A was provided for payment rates for telehealth:
Q: How much does Medicare pay for telehealth services?
A: Medicare pays the same amount for telehealth services as it would if the service were furnished in person. For services that have different rates in the office versus the facility (the site of service payment differential), Medicare uses the facility payment rate when services are furnished via telehealth.
The CMS telehealth FAQ is being utilized by the plan to guide the processing of payments for telehealth services for CMC Medicare Members and can be found at https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
Concerns Regarding Possible Provider Office Closures
IEHP has been contacted by a few Provider offices inquiring as to whether they should close their offices. We recommend that Providers adhere to County Public Health and CDC guidance re: how to protect their office staff. We want to remind Providers that you are responsible to provide coverage for your patients and should use telehealth whenever possible to support the needs of your patients. It is not appropriate to rely on Urgent Cares or the Emergency Department for coverage for your office.
If you have to close your office, please contact IEHP and advise on what your coverage and direction for Members will be to ensure that Members do not have a gap in care. Some Providers are rescheduling (or transitioning to telehealth) non-urgent or routine services for the next few weeks but it is up to each Provider to determine the appropriate protocol following CDC and public health guidance.
Behavioral Health Resources during COVID-19
County Crisis Resources (PDF) - April 01, 2020
Guidance for OB/GYNs
These FAQs are based on expert opinion and are intended to supplement the Centers for Disease Control and Prevention (CDC) guidance and the American College of Obstetricians and Gynecologists (ACOG) Practice Advisory with information on how to optimize obstetric care in the context of COVID-19.
- Obstetric Care and COVID-19 (PDF) - March 26, 2020
- The American College of Obstetricians and Gynecologists (ACOG) COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics - March 25, 2020
Guidance Regarding Testing for COVID-19
If your Members are assigned under LabCorp or Quest Diagnostics and you have the swabs and ability to collect the specimens to send to these labs for COVID-19 testing, please do so and refer to the lab pages for these vendors for the most up to date procedures. Remember, do not send your Members directly to these labs for testing. Please follow appropriate protocol to send specimens to the labs.
- Quest Diagnostics: https://www.questdiagnostics.com/home/Covid-19/HCP/#faqs
- Quest - COVID-19 Specimen Collection Device Guidelines (PDF) - March 24, 2020
- Fact Sheet for Healthcare Providers - cobas SARS-CoV-2 (PDF) - March 24, 2020
- Fact Sheet for Healthcare Providers - Quest SARS-CoV-2-rRT-PCR Quest Diagnostics (PDF) - March 24, 2020
If you do not have the ability to collect specimens for COVID-19, please refer to your County Public Health resources for guidance on directing Members for testing
Testing Available for IEHP Members at SAC Health System’s G Street Location
Beginning on Wednesday, March 25th, SAC Health System is offering testing for IEHP Members at their main campus, located at 250 South G Street, San Bernardino.
IEHP Members do not need to be assigned to SAC Health Systems to schedule a telephone appointment with a clinician to determine if COVID-19 testing is needed or to have the COVID-19 test done by SAC Health System.
Members can call (909) 771-2911 to schedule a telephone appointment with a clinician. The clinician will do a phone visit where they evaluate the Member and determine if they need COVID-19 testing.
If a Member needs testing, they will be directed to the outdoor Garden clinic at SAC Health System’s 250 South G Street location for testing.
SAC Health Systems will follow up with the Member regarding results when available (typically 3 – 5 days.)
See below for instructions on testing for each county's Public Health Department:
Riverside County Public Health
San Bernardino County Public Health
Beginning Monday, March 16, Riverside University Health System is standing up limited testing for individuals at all RUHS FQHC locations. All tests must be scheduled; walk-in patients may not be facilitated. Please instruct patients to call 800-720-9553 to schedule a COVID-19 or coronavirus test.
Testing can still be performed through the Department of Public Health. Testing requested through the Department of Public Health requires approval. Please call 951-358-5107 during business hours or after hours 951-782-2974 for on-call if urgent or emergent.
MEMORANDUM: Important Covid-19 Update for Referring Providers to RUHS Specialty Clinics (PDF) - March 31, 2020
BY APPOINTMENT ONLY Novel Coronavirus COVID-19 Testing (PDF) - March 20, 2020
Coachella Valley BY APPOINTMENT ONLY Novel Coronavirus COVID-19 Testing (PDF) - March 19, 2020
Public Health Advisory: COVID-19 Testing Availability (PDF) - March 17, 2020
Please refer to the Riverside County Public Health System website for guidance on the latest criteria for who should be tested.
San Bernardino County Department of Public Health offers several resources for guidance for Providers regarding evaluating patients who may have COVID-19 and testing. Please refer to wp.sbcounty.gov/dph/coronavirus and review the section “Guidance for Healthcare Providers.” You will find there information on the intake of specimens and where to send them for public health testing. Providers may call the DPH Communicable disease section for guidance on diagnosis and infection control:
- 800-722-4794 (8 am – 5 pm, Monday to Friday)
- 909-356-3805 (After Hours Duty Officer)
Visit San Bernardino County's Public Health to view all SBCPH news releases.
Key Points for Healthcare Providers on COVID-19 testing (PDF) - March 18, 2020
Department of Health Care Services (DHCS) and California Department of Public Health (CDPH) COVID 19 Response
Department of Health Care Services (DHCS)
California Department of Public Health (CDPH)
The California Department of HealthCare Services (DHCS) has published a COVID-19 response page with guidance for Providers and Partners, Home and Community Based Services and Behavioral Health.
Found Here: DHCS COVID‑19 Response
The California Department of Public Health (CDPH) also has a page with new guidance documents and additional resources and news releases.
Routine Childhood Immunizations during COVID-19 Pandemic (PDF) - March 31, 2020
Found Here: CDHP COVID-19 Updates
Centers for Medicare & Medicaid Services (CMS)
Updated CMS Rules and Waivers of Federal Requirements (issued March 30, 2020) to Address Patient Needs During the COVID-19 Pandemic (PDF) - March 31, 2020
Riverside County Medical Association (RCMA) COVID-19 Resources
The Riverside County Medical Association has published a COVID-19 Resource guide and documents. Here you will find links to their Telehealth guide, Telehealth billing document, a resource document for the new wage, unemployment and employer compensation, and a resource document on financial resources for the medical practice.
Found Here: RCMA COVID-19 Resources
2-1-1 San Bernardino County Resource & Information Guide
2-1-1 San Bernardino County has curated a COVID-19 Resource & Information Guide and will update this page regularly as the situation changes.
Found Here: 2-1-1 San Bernardino COVID-19 Resource & Information Guide
Pharmacy Times
- URGENT NOTICE: Hydroxychloroquine Formulary Change (PDF) - March 25, 2020
Correspondences:
- COVID-19 Update - Supply Requests and Protocols Q&As
- Reminder: Pharmacy Mail Order Services
- Telehealth Services Due to Limiting Exposure to COVID-19
- Public Health Advisory - Community Transmission of COVID-19 in the Coachella Valley and Countywide Testing Availability (PDF) - March 12, 2020
- San Bernardino County Public Health Guidance on COVID-19 (PDF) - March 12, 2020
- Public Health Advisory - Status Update on COVID-19 Coronavirus (PDF) - March 05, 2020
- CORONAVIRUS: How To Protect Yourself (PDF) - March 04, 2020
- CORONAVIRUS (COVID-19) Webinar for Clinicians (PDF) - March 03, 2020
For additional resources regarding COVID-19, please visit:
- Centers for Diease Control and Prevention (CDC)
- Riverside County Public Health
- San Bernardino Public Health
2020
Medicare Beneficiary Identifier (MBI)
The MACRA Act of 2015, mandates Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSN) from all Medicare cards to address the risk of Medicare beneficiary medical identity theft. CMS will mail out new Medicare Cards to Medicare Beneficiaries starting April 2018 through April 2019.
By clicking on the CMS web links below, you will be leaving the IEHP website.
For more information regarding the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.html.
For an overview of the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.
New Medicare card resources:
- New Medicare Card: Information for Partners & Stakeholders (PPT)
- You're getting a new Medicare card! (PDF)
- New Card! New Number! (PDF)
- "10 Things to Know About Your New Medicare Card" (PDF)
- Your New Medicare Card: Information for People with Medicare (PPT)
For additional resources regarding the new Medicare cards, please visit https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-Employers.html.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.Newsletters
Don't miss out on the latest news! The Heartbeat, IEHP's Provider Newsletter; ScrubTalk, Provider Staff Newsletter; keep you in the know about our newest programs, incentive opportunities, study results, and more.
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.
Proposition 56
Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, now includes proposed supplemental payments for physicians participating in Medi-Cal Fee-For-Service (FFS) and Medi-Cal Managed Care.
- Proposition 56 Extension Notice SFY 19/20 (PDF) Published: February 18, 2020
- Proposition 56 FAQs SFY 19/20 (PDF) Published: February 18, 2020
- Proposition 56 Extension Notice SFY 18/19 (PDF) Published: October 23, 2018
- Proposition 56 FAQs SFY 18/19 (PDF) Published: October 23, 2018
Electronic Payments
With the current public health situation that our country is experiencing, it is necessary for IEHP to take additional precautions to ensure the health and well-being of our community. These precautions are being reviewed, and discussed daily, by our Executive leadership team and will be implemented as deemed necessary. Future COVID-19 precautions may include reduced on-site staffing and prioritization of electronic payments over printed checks.
To minimize any disruption or delay in payment, we recommend that you sign up for electronic payments as soon as possible if you have not done so already. Our team is available to assist you with the necessary paperwork required to make this change or to answer any questions you may have. The team can be reached by e-mailing vendormaintenance@iehp.org or by calling (909) 294-3928 and selecting Option 1.
Our priority remains keeping our Members, Providers, Vendors, and Team Members safe while doing what we can to minimize the potential spread of the virus. We will continue to work hard to provide you with the level of service you have come to expect during this uncertain time.
Adverse Childhood Experiences Screening (ACES) Services
- Proposition 56 Adverse Childhood Experience Screening (ACES) Services (PDF) Published: March 19, 2020
- FAQs on Proposition 56 Payment Adverse Childhood Experience Screening (ACES) Services (PDF) Published: March 19, 2020
Developmental Screening Services
- Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020
- FAQs on Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020
Proposition 56 Payment Schedule
- Proposition 56 Supplemental Payment Schedule FY 19/ 20 (PDF) Published: March 19, 2020
Proposition 56 Payment Dispute Process
- Proposition 56 - Paid Claims Dispute Request Form (PDF)
- Proposition 56 - Encounter Dispute Request Form (PDF)
Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Ground Emergency Medical Transport (GEMT) Payment
The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019.
Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Proposition 56 - Value Based Payments (VBP) Program
The Proposition 56 VBP Program provides directed payment to incentivize Providers for meeting specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas are 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
- IEHP DHCS Value Based Payment Program Guide is Now Available! (PDF) - Published March, 27, 2020
- Value Based Payments (VBP) Program Guide (PDF) - Published: March 26, 2020
Value Based Payments Dispute Forms
- Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: March 19, 2020
- Value Based Payments Program - Encounter Dispute Request (PDF) Published: March 19, 2020
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.
Public Health Advisory
- Community Transmission of COVID-19 in the Coachella Valley and Countywide Testing Availability (PDF) - March 12, 2020
- San Bernardino County Public Health Guidance on COVID-19 (PDF) - March 12, 2020
- Community Transmission of COVID-19 in the Coachella Valley (PDF) - March 09, 2020
- Status Update on COVID-19 Coronavirus (PDF) - March 5, 2020
- Severe Acute Pulmonary Disease Associated with Cannabis or Cannabidiol Oil (PDF) - August 15, 2019
- Nationwide Shortage of Tuberculin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice (PDF) - August 5, 2019
Riverside County Public Health
San Bernardino County Public Health
Centers for Disease Control and Prevention (CDC)
The CDC has developed a one-stop-shop toolkit with products about vaccines and measles. These products include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. (By clicking the links below, you will be leaving the IEHP website.)
California Department of Public Health (CDPH)
The California Department of Public Health (CDPH) has developed two new measles tools for providers. Both tools are attached and can be found on the CDPH Measles Disease webpage. (By clicking on this link, you will be leaving the IEHP website.)
- Summary of Current Recommendations on Measles Immunization CDPH (PDF)
- Should I Test for Measles: A Guide for California Healthcare Providers (PDF)
Regulatory Updates
Read APL 17-009 (PDF) and DPL 17-002 (PDF) for information regarding Provider-Preventable Conditions. Visit Reporting of Provider Preventable Conditions for DHCS instructions for online reporting. By clicking on these links, you will be leaving the IEHP website.
Medicare Outpatient Observation Notice (MOON)
In the event any Medicare recipient has been in a status of outpatient observation for greater than 24 hours, Acute Hospitals are required to provide Medicare Members with a Medicare Outpatient Observation Notice (MOON). Medicare recipients must receive the MOON within 36 hours of admission to observation level of care.
Please refer to the following website for further details on MOON requirements at https://www.federalregister.gov/articles/2016/08/22/2016-18476/medicare-program-hospital-inpatient-prospective-payment-system-for-acute-care-hospitals-etc. By clicking on this link, you will be leaving the IEHP website.
Document Catalog:
- MOON FAQs (PDF)
- MOON Instruction Summary (PDF)
- CMS Manual System 10611_Pub 100-04 Medicare Claims Processing MOON Instructions (PDF)
- MOON Forms
- MOON Correspondence (PDF)
Cal MediConnect Quality Withhold Measures
- Cal MediConnect Quality Withhold Measures (PDF)
- California Specific Quality Withhold Technical Notes for DY 2 to 5 (PDF)
- Core Quality Withhold Technical Notes for DY 2 to 5 (PDF)
Flu Updates
The flu season is upon us and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) published the updated recommendations regarding the use of influenza vaccine. Vaccine manufacturers are expected to provide adequate vaccines this year.
To assist you, IEHP will continually update you on the latest recommendations, news and resources on these flu viruses. As the flu season progresses, you may see an increase in office visits from the Members with flu-like symptoms - and if they are unable to reach you after hours, refer them to our 24-hour Nurse Advice Line, 7 days a week, including holidays at (888) 244-IEHP (4347).
- Careful Antibiotic Use (PDF)
- Pediatric Clinical Practice Guideline Summary (PDF)
- Adult Clinical Practice Guideline Summary (PDF)
Web Resources
By clicking on these links, you will be leaving the IEHP website.Preventive Services
Immunizations
By clicking on these links, you will be leaving the IEHP website.- CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
- CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
- CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html
- USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization
- California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do
- Immunization Timing 2020 (PDF)