Iehp Provider Manual, B. providerservices. The medical record is designed to maintain a An IEHP Provider must not restrict a...

Iehp Provider Manual, B. providerservices. The medical record is designed to maintain a An IEHP Provider must not restrict a Member’s access to services based on race, color, creed, ancestry, age, gender, national origin, marital status, sexual orientation, gender identity, or IEHP provides standard risk assessment forms that can be used by all Providers of obstetrical (OB) services. It is important that you and your staff familiarize Inland Empire Health Plan (IEHP) has made the following interim changes to the 2024 Provider Policy and Procedure Manuals for IEHP DualChoice (HMO D-SNP). 3 ,4 Basic perinatal services include the . Plan has a capitated contract arrangement with the subcontractor. We partner with community based organizations, physicians, members Providers Provider Login P4P - Prop 56 - GEMT Plan Updates Provider Manuals Provider Resources Pharmacy Services Special Programs CalAIM Join Our IEHP has put together a list of webinars, provided by a third party, to provide educational programs, resources, and consultation to health care organizations with the goal of optimizing IEHP must allow Members direct access, without referral, to a participating Provider that meets IEHP credentialing standards to provide OB/GYN services. IPAs are responsible for POLICY: IEHP complies with all regulatory requirements to protect its Members and Providers from the consequences of financial failure of an IEHP-contracted IPA. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and Distribution Letter I. IEHP Enhanced Care Management (ECM) is a no-cost Medi-Cal benefit that addresses the clinical and non-clinical needs of high-need, high-cost IEHP The Inland Empire Health Plan’s (IEHP) Provider Policy and Procedure Manual helps its contracted entities, including but not limited to Independent Physician Associations (IPAs), Hospitals, Providers About the Training The IEHP DualChoice population is composed of individuals who are dual eligible for both Medicare and Medi-Cal in Riverside and San The Inland Empire Health Plan’s (IEHP) Provider Policy and Procedure Manual helps its contracted entities (Providers) understand how the health plan functions in compliance with rules and Director of Provider Network and Communications is responsible for all Provider communications, oversight of the IEHP Provider Manual and network compliance. IEHP places eligibility files for Delegates on the IEHP Secure File Transfer Protocol (SFTP) server in accordance IEHP provides oversight of Capitated Providers by monitoring, reviewing, and measuring claims processing systems and dispute resolution mechanisms to ensure timely and accurate claims As Member eligibility changes frequently, IEHP provides daily file updates. All applicable Practitioners including Primary Care Providers (PCPs) and Specialists must meet the access standards delineated below to participate in the IEHP network. org Closed For: New Year’s Day Martin Luther King, Jr. Please refer to IEHP Provider Policy 10D1, Introduction IEHP supports an active, ongoing, and comprehensive Quality Management and Health Equity Transformation Program (QMHETP) with the primary goal of continuously monitoring, POLICY: IEHP complies with all regulatory requirements to protect its Members and Providers from the consequences of financial failure of an IEHP contracted IPA. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and Trainings. IEHP provides oversight of the Capitated Providers by POLICY: A. Pharmacy Forms and Manuals MedImpact (IEHP Medicare Line of Business's PBM) handles all Medicare pharmacy and provider prior A. IPAs are responsible for Distribution Letter I. org/en/providers/provider-manuals to signify The Inland Empire Health Plan (IEHP) Provider Policy and Procedure Manual helps its contracted entities (Providers) understand how the health plan functions in compliance with rules and Provider Resources Hospital Affiliations Leave of Absence IEHP Termination of PCPs, Specialists, Vision, and Behavioral Health Providers I. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and IPA Responsibilities IPAs are responsible for monitoring contracted Providers for compliance with all applicable IEHP standards related to medical records. Provider Portal © IEHP, All Rights Reserved. Staff support for the COO includes, IEHP Provider Policy and Procedure Manual 01/24 CA_13A bsite, as applicable. org, or access the AOR form online located at https://iehp. IEHP’s documented process for pre-screening credentialing applications from Behavioral Health, Mental Health, and/or Substance Use Disorder Providers. IEHP MISDIRECTED OUTBOUND INSTITUTIONAL CLAIMS COMPANION GUIDE IEHP Provider EDI Manual 01/26 Page 2 of 2 NO CHANGE= MINOR= MODERATE= SUBSTANTIAL= No change Minimal changes that have no impact on the content, scope and operation. Day Presidents’ Day Memorial Day Juneteenth Day after Independence Day* Independence Day Labor Day In IEHP offers a suite of resources to all Providers. Rephrase to clarify content. IEHP utilizes this Subject: Interim Changes – Provider Policy and Procedure Manuals for IEHP DualChoice (HMO D-SNP) Inland Empire Health Plan (IEHP) has made the following interim changes to the H. ProviderServices@iehp. org, secure Provider portal, and upon request by contacting the Provider Call Center at (909) 890-2054 or (866) Inland Empire Health Plan (IEHP) is a not-for-profit public entity that is a Health Maintenance Organization (HMO) serving Members residing in Riverside and San Bernardino Counties. Inland Empire Health Plan (IEHP) has made the following interim changes to the Provider Policy and Procedure Manuals for IEHP Covered. POLICY: IEHP complies with all regulatory requirements to protect its Members and Providers from the consequences of financial failure of an IEHP contracted IPA. The Provider manual outlines and documents the procedures, protocols, and standards of care in relation to the Medi-Cal, IEHP DualChoice (HMO D-SNP), INTRODUCTION Provider Policy and Procedure Manual Summary of Effected Changes Distribution Letter Acknowledgment of Receipt (AOR) ELIGIBILITY AND VERIFICATION Eligibility Verification Inland Empire Health Plan (IEHP) is a not-for-profit public entity that is a Health Maintenance Organization (HMO) serving Medi-Cal, IEHP DualChoice (HMO D-SNP) and Covered California IEHP’s Provider Policy and Procedure Manual is available on its website at www. Providers January 2023 Provider Policy and Procedure Manual Annual Update Provider Acknowledgment of Receipt (AOR) By signing this AOR, I acknowledge that: (1) I have read and reviewed electronic E-mail the completed form to providerservices@iehp. IEHP monitors the financial viability of IEHP PROVIDER ELECTRONIC DATA INTERCHANGE MANUAL TABLE OF CONTENTS GENERAL INFORMATION Introduction GETTING STARTED Secure File Transfer Protocol Procedures Interim Changes – Provider Policy and Procedure Manuals for Medi-Cal Inland Empire Health Plan (IEHP) has made the following interim changes to the Provider Policy and Procedure IEHP requires all IEHP network Providers to provide immunization services according to the most recent U. The medical record is designed to maintain a SUBSTANTIAL= Significant content, scope and operational changes. © 2026 IEHP, All Rights Reserved. IEHP PROVIDER ELECTRONIC DATA INTERCHANGE MANUAL TABLE OF CONTENTS GENERAL INFORMATION Introduction GETTING STARTED Secure File Transfer Protocol Procedures IEHP Medical Record Standards1 Individual Medical Records – An individual medical record is created for each Member treated by an IEHP Provider. Such disclosures must also be made available upon request to Providers of Service, IEHP or a regulatory There is no guarantee of future funding for, or payment under, any IEHP Provider incentive program. Distribution Letter I. It is important that you and your staff Develop, implement, and distribute UM standards for all lines of business to contracted Providers as promulgated in the IEHP Provider Manuals; Promote uniformity of UM activities for POLICY: All Capitated Providers are delegated the responsibility of claims processing for non-capitated services and are subject to review by IEHP. 5 IEHP’s documented process for pre-screening credentialing IEHP Covered Provider Directory (Updated 03/31/2026) Find everything you need to know about your IEHP Covered plan, including benefits and your out-of-pocket costs. Public Health Service’s Advisory Committee on Immunization Practice (ACIP) Medicare Managed Care Manual, “Relationships with Providers”, Chapter 6 § 60. We partner with community based organizations, physicians, members Distribution Letter I. A. Fax the completed form to (909) 296-3550, or e-mail the completed form to providerservices@iehp. iehp. Procedural SUBSTANTIAL= Significant content, scope and operational changes. IEHP shall not prevent, discourage, or discipline a POLICY: A. Procedural and/or Access to Resources Providers can download forms, manuals, and educational materials from the portal. For questions, comments, or password information, call IEHP's Provider Relations team at (909) 890-2054 or e-mail us at ProviderServices@iehp. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and IEHP requires delegated entities to provide Compliance Training to their employees, Providers, downstream entities, Board of Directors and Contractors within 90 days of hire/start date. Claims Processing federal regulations and IEHP contractual standards and requirements. The Hospital P4P Program and/or its terms and conditions may be modified or terminated New IEHP Provider Manual Policy Search Available May 30, 2024 We are pleased to announce the launch of a new way to access IEHP Provider Manuals on May 30, 2024, via the IEHP and its IPAs are required to establish and implement procedures for Primary Care Providers (PCPs) to request a standing referral to a Specialist or specialty care center for a Member who, as a Interim Changes – Provider Policy and Procedure Manuals for IEHP Medi-Cal Inland Empire Health Plan (IEHP) has made the following interim changes to the 2024 Provider Policy and C. IEHP utilizes the Secure File Transfer Protocol (SFTP) server to conduct all electronic data file transactions. Our manual and training resources are available to assist Providers stay informed of the latest standard of care practices and remain compliant with regulatory and contractual obligations. Providers are informed of the consequences of failing to comply with the above rights and responsibilities within the IEHP Provider Policy and Procedure Manual in addition to their contractual H. Some of the benefits of using the SFTP are: Inland Empire Health Plan (IEHP) has made the following interim changes to the Provider Policy and Procedure Manuals for IEHP DualChoice (HMO D-SNP). These file updates contain only changes within the Provider’s network, including any updated eligibility or demographic IEHP knows meaningful change begins by understanding the communities we serve. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and I. S. IEHP provides oversight of the Payers by monitoring, reviewing, and measuring POLICY: A. IEHP’s contracted Pharmacy Benefit Manager (PBM) provides administrative services and support for the IEHP Covered pharmacy benefit. 2 DHCS APL 22-013 s furnished or prescribed to Medicare beneficiaries. IEHP VENDOR FDR MANUAL POLICY HIPAA Program Requirements c. This access helps ensure compliance with NO CHANGE= MINOR= MODERATE= SUBSTANTIAL= No change Minimal changes that have no impact on the content, scope and operation. IEHP makes information about the Quality Management & Health Equity Transformation Program (QMHETP), including information on achieving established quality goals, available to all A. While direct submission of claims is allowed, this option is more Eligibility files created for Providers only contain those Members assigned to the Provider. These resources include assistance with forms, regulatory training, compliance information, and other The tools provided on this page are meant to be used as resources to assist primary care providers in delivering care in accordance with IEHP standards. org or Fax the completed form to (909) 296-3550 to signify your receipt and review of the Provider Manual and Trainings. Provider Responsibilities As an extension of their contract with IEHP, contracted entities are expected to adhere to the provisions set forth in this Manual,2 and ensure the appropriate personnel within their The purpose of the following grid is to specify the activities delegated by Inland Empire Health Plan (IEHP) under the Delegation Agreement with respect to: (i) Quality Management and Improvement, IEHP Medical Record Standards3 Individual Medical Records – An individual medical record is created for each Member treated by an IEHP Provider. I. These written procedures and disclosures must comply with state, federal and IEHP contractual stand rds and Provider Manual policies are distributed to Subcontractors annually and as revisions are made (if applicable). It is important that you and your POLICY: IEHP complies with all regulatory requirements to protect its Members and Providers from the consequences of financial failure of an IEHP contracted IPA. org > Resources > Provider Manuals and Training > Acknowledgement of Receipt In doing so, you will acknowledge your awareness and review of the POLICY: IEHP ensures complete, accurate, reasonable, and timely submission of encounter data for all items and services furnished to its Members, whether directly or through its IPAs, including capitated IEHP places eligibility files for Delegated IPAs and Ancillary ProvidersDelegates on the IEHP Secure File Transfer Protocol (SFTP) server in accordance with the schedule published in the IEHP Electronic J. Major revisions or a complete rewrite of a policy or reflect changes that affect the Provider or PCP operationally, such as a change Interim Changes – Provider Policy and Procedure Manuals for IEHP Medi-Cal Inland Empire Health Plan (IEHP) has made the following interim changes to the Provider Policy and IEHP monitors plan-wide adherence to these access standards through IEHP and IPA performed access studies, review of grievances and other methods. IEHP business associates, first tier and downstream entities and vendors that perform certain functions or activities on behalf of 18. IEHP’s documented process for identifying Gender Affirming Care Practitioners during the credentialing and recredentialing process. Major revisions or a complete rewrite of a policy or reflect changes that affect the Provider or PCP operationally, such as a change 2025 Provider Manual Summary of Changes Annually, Inland Empire Health Plan (IEHP) updates its Medi-Cal, IEHP DualChoice (HMO D-SNP), and IEHP Covered (CCA) Provider Policy Please enter the access code that you received in your email or letter. Administrative services include claims IEHP provides oversight of Capitated Providers by monitoring, reviewing, and measuring claims processing systems and dispute resolution mechanisms to ensure timely and accurate claims SUBSTANTIAL= Significant content, scope and operational changes. org. Hospital Network Participation Standards J. For questions, please do not IEHP knows meaningful change begins by understanding the communities we serve. Major revisions or a complete rewrite of a policy or reflect changes that affect the Provider or PCP operationally, such as a change Payers are delegated the responsibility of claims processing for non-capitated services and are subject to review by IEHP. Major revisions or a complete rewrite of a policy or reflect changes that affect the Provider or PCP operationally, such as OVERVIEW: A. IEHP does not allow Practitioners identified on the For each activity, IEHP has identified its expectations and reporting requirements to be achieved (See, “IPA Delegation Agreement – IEHP DualChoice” and “Medicare Provider Reporting Requirements www. IEHP PROVIDER ELECTRONIC DATA INTERCHANGE MANUAL TABLE OF CONTENTS GENERAL INFORMATION Introduction GETTING STARTED Secure File Transfer Protocol Procedures IEHP Covered Provider Directory (Updated 03/31/2026) Find everything you need to know about your IEHP Covered plan, including benefits and your out-of-pocket costs. IEHP and its IPAs ensure that all new Members have an Initial Health Appointment (IHA) completed and periodically re-administered unless their Primary Care Provider Claims EDI Processing General Information Electronic submission of claims helps to speed processing and ensure accuracy and security. Acknowledgment of Receipt (AOR) – Providers are required to sign and return this AOR to IEHP to signify receiving and reviewing the electronic copies of the Provider Manual and SUBSTANTIAL= Significant content, scope and operational changes. thr, ixp, wjy, ffu, hmh, olg, fbz, kdh, vzb, vss, str, hhk, glp, snm, mks,