Our nutrition and diet programs are designed to help patients maintain a healthy weight. Please select the Appeal and Grievance form appropriate for their use: Inland Empire Health Plan (IEHP) offers you easy access to useful reference materials and forms you may need. Being aware of what will be covered, how much your insurance plan will pay and every one of the services you will get when in rehab treatment will likely significantly limit, if not do away with altogether, the chances of you paying extra funds out of pocket right after rehab. When I run it hurts from the pulling. It depends which company you use, and this is constantly changing - more and more companies are starting to cover Holistic Nutritionists. Identification with both a picture and a signature, such a valid driver's license or State identification card, are suggested. They might, for example, plan a diet with reduced processed foods and sugar to help … E-mail: stopmedicalfraud@dhs.ca.gov. Providers may obtain information about criteria, either in general or relating to specific UM decisions, from IEHP upon request by contacting the IEHP UM Department. Erin. You can download a free copy by clicking here. Our goal in creating this page is to provide you with easily accessible electronic versions of IEHP’s UM guidelines. Further information is available on the following pages: Medicare and Medi-Cal lines of business must follow the instructions below: Category 1 - HCACs (For Any Inpatient Hospital Setting in Medicaid), Category 2 - Other Provider Preventable Conditions (For Any Health Care Setting). If you get dialysis in a dialysis facility, Medicare covers Medical Nutrition Therapy as part of your overall dialysis care. If you are still not sure if it is for you review a free video demonstration Here. Physicians may also give treatment advice, refill select prescriptions and refer Members for in-person care. E-mail: compliance@iehp.org, Online: (By clicking on the following links, you will be leaving the IEHP website), Report a Privacy Incident/Breach Click Here. In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. Resources are not limited to webinars, computer based training, and webinars. Medi-Cal: Frames and lenses are covered once every 24 months. does iehp cover dental – this topic people are often interested in, because there are important reasons for this. As of June 1, 2018, IEHP has put policies and procedures in place to comply with these process and reporting requirements: To access the On-Site training material presented to IPAs and County Mental Health Clinics, click here (PDF). The call is free and the caller may remain anonymous. The Staying Healthy Assessment (SHA) forms consist of seven age-specific pediatric questionnaires and two adult questionnaires. If someone says they are an RD, they have gone through standardized education and experience to get their nutrition knowledge. (866) 294-4347 Welcome and Thank You for your participation in the IEHP Network and partnering with us to offer our members the highest quality care and service they need. 2. Bình Chữa Cháy Khí Co2 – Kiểm Định BCA; Bình Chữa Cháy Foam – Dung Dịch Foam; Bình Chữa Cháy Bột -BC – ABC – Kiểm Định BCA AHRQ Health Literacy Modules Available for Continuing Education (CE) and Maintenance of Certification (MOC) Credit. Cases From a Sexual Health Clinic, Insurance Considerations for Navigating Gender-affirming Care, Building Your Family: LGBTQ Reproductive Options, Behavioral Health Assessments and Referral for Gender-Affirming Surgery, Collecting Sexual Orientation and Gender Identity (SO/GI) Data In Electronic Health Records, Providing Mental Health Assessments for Gender Affirming Surgery Referral Letters, https://www.ahrq.gov/health-care-information/topics/topic-health-literacy.html, https://cccm.thinkculturalhealth.hhs.gov/, ABA 6 Month and Exit Progress Report Template (Word), ABA School BHT Services Request Form (Word), Authorization Release of Information Form - English (PDF), Authorization Release of Information Form - Spanish (PDF), Behavioral Health Authorization Request Form (PDF), Coordination of Care Treatment Plan Form (PDF), Psych Testing Battery Plan (for Psychologist use only) (PDF), Clean Claim Tool Guide - UB04 Inpatient Form (PDF), Clean Claim Tool Guide - UB04 Outpatient Form (PDF), Waiver of Liability Statement - Cal MediConnect Plan (PDF), Revised CMS 1500 Health Insurance Claim Form (PDF), CMS 1500 Reference Instruction Manual (PDF), Compliance Program Effectiveness DOA Audit Tool - Medi-Cal, Compliance Program Effectiveness DOA Audit Tool - Medicare, Sub-Contracted Facility/Agency Services and Delegated Functions (PDF), Electronic Funds Transfer (EFT) Form & FAQs (PDF), Positive Airway Pressure Devices for Obstructive Sleep Apnea (PDF), Transcutaneous Electrical Nerve Stimulator (TENS) (PDF), Referral Authorization Request Form - Non-Contracted Providers (PDF), Edinburgh Postnatal Depression Screening Tool - English (PDF), Edinburgh Postnatal Depression Screening Tool - Spanish (PDF), Initial and Trimester Assessment and Care Plan (PDF), Postpartum Assessment and Care Plan (PDF), Pregnancy Notification/Outcome Report (PDF), Instructions for Completing Online Reporting of PPCs, Medi-Cal Guidance on Reporting Provider-Preventable Conditions, Authorization for Use and/or Disclosure of Patient Health Information - English (PDF), Authorization for Use and/or Disclosure of Patient Health Information - Spanish (PDF), Contraceptive Informed Choice Form - English (PDF), Contraceptive Informed Choice Form - Spanish (PDF), Diabetic Prescription Referral Form -Preveon Health (PDF), Health Risk Assessment (HRA) - IEHP DualChoice - English (PDF), Health Risk Assessment (HRA) - IEHP DualChoice - Spanish (PDF), HIV Testing Sites - Riverside and San Bernardino (PDF), Non-Emergency Medical Transportation (NEMT) Physician Certification Statement (PCS) (PDF), Pain Assessment and Treatment Plan Form (PDF), Service Request for Skilled Nursing Facilities (PDF), Transportation Requests Form (SNF & LTC) (PDF), Transportation Requests Form (Hospital) (PDF), Vision Exception Request (VER) Form (PDF), Non Covered Services/Materials Waiver Form-English (PDF), Non Covered Services/Materials Waiver Form-Spanish (PDF), Authorization of Release - Use & Disclosure of PHI - English (PDF), Authorization of Release - Use & Disclosure of PHI - Spanish (PDF), CMS 1696 Appointment of Representative - English (PDF), CMS 1696 Appointment of Representative - Spanish (PDF), Provider Services Materials Request Form (PDF), 2017 Model Output Report (MOR) Data File Layout (PDF), Department of Health Care Services (DHCS), APL20-006 - Facility Site Review and Medical Record Review (PDF), DPL14-005 - FSR Physical-Accessibility Reviews (PDF), PL14-004 - Facility Site Review and Medical Record Review (PDF), Att 06 - IEHP Urgent Care Evaluation Tool (PDF), Medical Record Review Audit Tool Sections, Medical Emergency, Earthquake, Fire Protocols (PDF), Adult Sterilization & Special Consent P&P (PDF), Required Documentation Checklist for Adult (PDF), Checklist for Safe Vaccine Storage and Handling (PDF), Controlled Substance Distribution Log (PDF), Monthly Expiration Date & Verification Log (PDF), P&P Distribution of Sample Medications (PDF), Patient Distribution Log for Samples (PDF), Plan for Vaccine Protection in Case of Power Outage (PDF), Vaccine Information Sheet (VIS) Protocol (PDF), Advance Health Care Directive Acknowledgement Form (PDF), Acknowledgment of Receipt of Notice of Privacy Practice (PDF), AAP Infection Prevention and Control in Pediatric Ambulatory Settings - COVID (PDF), Bloodborne Pathogens & Post Exposure Plan - Fillable (PDF), Infection Control, Biohazardous Waste and Disposition of Patients with Contagious Disease (PDF), Isolation & Transmissions Based Precautions (PDF), P&P Autoclaving Instruments in Peel (PDF), P&P Transport for Reusable Instruments (PDF), Transfer Stations and Treatment Facilities (PDF), CPSP Initial and Trimester Assessment and Care Plan (PDF), CPSP Postpartum Assessment and Care Plan (PDF), Edinburgh Postnatal Depression Scale (EPDS) (PDF), Required Documentation Checklist for OB (PDF), Primary Care Provider Timeframe Access Standards (PDF), CDC Growth Chart Head Circumference - Boys (PDF), CDC Growth Chart Head Circumference - Girls (PDF), CDC Growth Chart Weight for Age - Boys (PDF), CDC Growth Chart Weight for Age - Girls (PDF), Required Documentation Checklist for Pediatric (PDF), What Do You Eat (8-19 years) - English (PDF), What Do You Eat (8-19 years) - Spanish (PDF), What Does Your Child Eat (Birth - 8 years) - English (PDF), What Does Your Child Eat (Birth - 8 years) - Spanish (PDF), Youth Nutrition and Activity Assessment (8 - 19 years) (PDF), Electronic Resources for Required Employee Training (PDF), IEHP Grievance Resolution Process - English (PDF), IEHP Grievance Resolution Process - Spanish (PDF), IEHP P&P Elder or Adult Abuse Reporting (PDF), IEHP P&P Sensitive Services-Access Standards (PDF), Medical Assistant Letter of Competency - Fillable (PDF), Medical Assistant Venipuncture Form (PDF), Medication Administration Procedures (PDF), Mid-level Supervision of Medical Assistant (PDF), Notice to Consumer PA Sign - English (PDF), Notice to Consumer PA Sign - Spanish (PDF), Standardized Procedures for Nurse Practitioner (PDF), Electronic Resources for Medical Record Review (PDF), Click here to visit the Skinny Gene Project online, 2016 Group Needs Assessment (GNA) Report (PDF), http://www.cdc.gov/tobacco/campaign/tips/resources/videos/rebecca-videos.html, http://www2c.cdc.gov/podcasts/player.asp?f=8639229, http://www.cdc.gov/tobacco/campaign/tips/resources/ads/tips-5-rebecca-full.pdf, http://www.cdc.gov/tobacco/campaign/tips/partners/health/mental/index.html, http://www.cdc.gov/tobacco/campaign/tips/resources/buttons/index.htm, American College of Physicians Foundation, Food and Drug Administration - Office of Women's Health, https://www.capolstregistry.org/#/mdsignup, https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/, U.S. Prevention Task Force (USPSTF) Recommendations for the Affordable Care Act (ACA) (PDF), Prescription Medication Refill List (PDF), LabCorp Patient Service Centers at Walgreens (PDF), Behavioral Health Home Based Services (PDF), Criteria for Multidisciplinary Treatment Services (PDF), Inflammatory Bowel Disease Serology (PDF), Full Integrated and Serum Integrated Screening (PDF), Bone Marrow Transplant in Treatment of Multiple Sclerosis (PDF), Physical Therapy Guidelines for Chronic Conditions (PDF), Pain Management - Centers of Excellence (COE) (PDF), Referrals to Pain Management Specialist (PDF), Deflux Injectable Gel for VUR in Children (PDF), Adolescent Bariatric Consultation and Surgery (PDF), Liver Biopsy in Conjunction with Bariatric Surgery (PDF), Natural Orifice Transluminal Endoscopic Surgery (PDF), Allocation of Limited Critical Care Resources During a Public Health Emergency (PDF), Chimeric Antigen Receptor T-Cell Therapy (CAR-T Therapy) (PDF), Complementary and Alternative Medicine or Holistic Therapies (PDF), Congregate Living Health Facilities (PDF), Criteria for Custodial Care: Medi-Cal (PDF), Hepatitis C - Center of Excellence (COE) Admission Criteria (PDF), My Path (A Palliative Care Approach) (PDF), Reference Product Pegfilgrastim and Biosimilar Products (PDF), Tertiary Care Center Referral Requests (PDF), Diabetes Prevention Program - Skinny Gene Project, IEHP Texting Program Terms and Conditions. IEHP also has the following resources available for reporting fraud, waste or abuse, Privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Facility Site Reviews are the required standards by the California Department of Health Care Services (DHCS)/Medi-Cal Managed Care Division (MMCD) for all primary care provider (PCP) sites. Topics are available in multiple languages. Insurance Coverage for Nutrition Counseling. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. Periodically perform internal audits of billing practices and compare billing records with payments received. Fax: (909) 477-8536 This online year-long lifestyle change program helps you make real changes that last. Regular food products are not considered medical items. Pediatricians and family physicians can earn credit for re-certification (MOC Part 2) as well as CE by taking the Health Literacy Knowledge Self-Assessment through the American Board of Pediatrics and the American Academy of Family Physicians, respectively. Adult Frames and Lenses: This includes all eye glasses frames and lenses covered up to the maximum allowed cost per requirements. Misusing codes on a claim, such as upcoding and unbundling codes. If you are considering Weight Loss Programs Covered By Iehp Health, a fitness program particularly designed for women of all ages. Some nutritionists provide customized information for specific individuals. The Grievance Forms below are for your Member's use when filing a complaint, or has an appeal regarding any aspect of care or service provided by you. 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. To find out about other free AHRQ continuing education opportunities, go to www.ahrq.gov. (866) 577-8355 (TTY), To Enroll with IEHP PCPs are responsible for assuring the Staying Healthy Assessment (SHA) Questionnaire is administered during the Initial Health Assessment to each IEHP Member within 120 days of the Member's enrollment.The SHA Questionnaire is available in over nine different languages and in nine separate age categories. Materials can be printed or ordered. IEHP Compliance Officer Therefore, the services of a dentist are a necessary and even inevitable thing in our life. Resources are reviewed regularly and updated to reflect changes from a regulatory and clinical standpoint. Please note that benefits may vary based on Member’s line of business; therefore, certain services discussed in the UM Subcommittee Guidelines may not be a covered benefit. An extensive list of health education materials about healthy weight and physical activity in English and Spanish. Do not leave prescription pads, which include a Provider's identification and license number, out in the open. Answer Save. As part of these instructions, the Health Plan, Network Providers, Delegates, Contracted Hospitals, and ambulatory surgical centers must report using PPC Form on DHCS secure online portal for both Medicare and Medi-Cal lines of business. Learn More . 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. No fees are charged for the two CE activities: 1. Inland Empire Health Plan (IEHP) is committed to conducting its health plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal and IEHP DualChoice.