IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. 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. If you are interested in becoming a network Provider, please click here. IEHP also has the following resources available for reporting fraud, waste or abuse, Privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 All content has been reviewed by IEHP to align with the standards practiced by leading health organizations. Active listening: Clients need complete attention when they are talking about their health issues, dietary concerns, and other challenges. Prior to contracts and monthly thereafter, review of the GSA System for Award Management (SAM), the Department of Health Care Services Medi-Cal Suspended and Ineligible list, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) that are excluded from participation in government health care programs (42 CFR §10011901). 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. Here, you will find links to the Pharmacy Program Manual, Communications, DTM Program, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information. Dealing with a disease or an illness can be overwhelming. IEHP has established a Fraud, Waste, and Abuse Program to detect, correct, and prevent fraud, waste, and abuse on part of Team Members, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. Format: Online (small group) Please contact the IEHP Provider Relations Team at (909) 890-2054 to be connected to the UM Department. ; Verbal communication: A significant part of a dietitian and nutritionist’s job involves conveying information to clients and their caregivers.Doing so effectively requires excellent communication skills and speaking skills. Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. Please refer to IEHP Provider Policy 10D1, "Obstetrical Services, Guidelines for Obstetrical Services" for further detail. Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression and other topics related to women’s health. It's just one click away. Drug & Alcohol Rehab Centers That Accept Inland Empire Health Plan IEHP Therefore, the services of a dentist are a necessary and even inevitable thing in our life. Aetna does not cover nutritional support that is taken orally (i.e., by mouth), unless mandated by state law. IEHP Providers can direct Members to access care after hours. Select Language: English, Spanish, Arabic, Armenian, Chinese, (PDF), Assisting Patients with Requests for Workplace Accommodations or Leaves of Absence (PDF), 2020 Care Management Delegation Oversight Medicare IPA Training (MP4 Video), Initial Health Assessment Standards (PDF), Staying Healthy Assessment (SHA) Training (PDF), SHA Pediatric Questions by Age Group (PDF), The National LGBT Health Education Center Webinars, HIV Prevention/PrEP at Health Centers: An Overview and Current Best Practices, What’s new in PrEP and STIs? No fees are charged for the two CE activities: 1. Asked By: jordyanhan in Hesperia, CA. Providers must complete the SHA Training. IEHP 24-Hour Nurse Advice Line (for IEHP Members only) (888) 244-4347 (866) 577-8355 (TTY) Provider Relations (909) 890-2054. Mail: To Enroll with IEHP (866) 294-4347 (800) 720-4347 (TTY) IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP … It is hard to say it depends on your policy, for one person with this insurance carrier it might and for someone else it might not. Nutrition is a major part of the conversation for pregnant women, hyperactive children, and those with cardiovascular issues, diabetes, and obesity. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form. If you are still not sure if it is for you review a free video demonstration Here. E-mail: compliance@iehp.org. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Easy to read “Handouts and Visual Aids” in color on diabetes care and nutrition to help patients eat the right foods to control blood sugar. Si usted tiene IEHP ¿Sabía que IEHP ofrece servicios de interpretación a todos los miembros de IEHP… Medical Nutrition Therapy Services Nutrition therapy is for people who have diabetes or kidney disease (but aren+t on dialysis or haven+t had a kidney transplant) when referred by a doctor. The Staying Healthy Assessment (SHA) forms consist of seven age-specific pediatric questionnaires and two adult questionnaires. Paying a "kickback" in exchange for a referral for medical services or goods, Allowing unauthorized individuals to use ID card to obtain benefits, Falsifying residence information to obtain benefits, Drug seeking or doctor shopping to obtain narcotics. RDs have to complete a standardized national test to get their credential after going through an internship that covers health care, food service and community practices. The Fenway Institute (TFI) is an interdisciplinary center for research, training, education, and policy development that works to ensure access to quality, culturally affirming medical and mental health care for traditionally underserved communities, including LGBTQIA+ people and those affected by HIV/AIDS. It may or may not require a pre-authorization by an insurance company, Doctors can make referrals to a nutritionist in cases that are not clearly spelled out by insurance, In some cases, nutrition services are included as a part of the federal Affordable Care Act, Some US states require insurers to provide additional nutritional service coverage for things like obesity and weight loss. Since medical technology is constantly evolving, our clinical guidelines are subject to change without prior notification. An extensive list of health education materials about healthy weight and physical activity in English and Spanish. To Enroll with IEHP (866) 294-4347 (800) 720-4347 (TTY) IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP DualChoice Member Services (877) 273-4347 (800) 718-4347 (TTY) IEHP 24-Hour Nurse Advice Line (for IEHP … Criminal record checks when appropriate or as required by law. Nondiscrimination Language Access Notice: You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. I am bmi 40 and have no health issues. DocOnline Physicians will triage, assess, and provide diagnoses for minor acute conditions. To Enroll with IEHP (866) 294-4347 (800) 720-4347 (TTY) IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP DualChoice Member Services (877) 273-4347 (800) 718-4347 (TTY) IEHP 24-Hour Nurse Advice Line (for IEHP … Let's start living the best version of you and living the life you love. Phone: (800) 822-6222 Welcome to the Utilization Management Clinical Criteria page. It will show you the concepts of the program in more feature, and also why losing weight is so much … The following numbers are to be used for after hour requests: A listing of LabCorp Patient Service Centers around the Inland Empire can be found below: Any of your IEHP Members needing medical attention may visit an Urgent Care Clinic after regular business office hours and on weekends. Make Sure You’re Covered; Coverage While Traveling; Personal Funding Accounts; Support; Life-Changing Diagnosis; Back Pain; Mental Health; Sleep; Stay Healthy; Preventive Health; Pregnancy; Dental ; Discounts; 5 reasons to consider a nutritionist Thursday, February 07, 2019. For any questions, please contact Care Directives at (888) 621-4383 or email support@caredirectives.org. A listing of all Urgent Care Clinics is found on the IEHP Doctor Search. For example, Medicare covers medical nutrition therapy services … Nutrition counseling is more likely to be covered if it is part of a doctor-prescribed treatment for a particular medical condition, such as diabetes, obesity, high blood pressure or coronary heart disease. In order to solve this problem, he always turned to the dentist. ou for your participation in the IEHP Network and partnering with us to offer our members the highest quality care and service they need. General Health Corporation Health Insurance, McDonald Health Insurance Company Health Insurance, Nutrition is often counted as a kind of preventative care, Nutritional services are covered by insurance if you have a diagnosis of a condition where nutrition counseling is a recognized treatment. 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. IEHP has the following resources available for reporting fraud, waste or abuse, Privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Yes. By clicking on these links, you will be leaving the IEHP website. And will IEHP cover it? To Enroll with IEHP (866) 294-4347 (800) 720-4347 (TTY) IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP DualChoice Member Services (877) 273-4347 (800) 718-4347 (TTY) IEHP 24-Hour Nurse Advice Line (for IEHP … Report a Privacy Incident/Breach Click Here (By clicking on this link, you will be leaving the IEHP website). I didnt think Id get approves so fast. Download free “Health Tips” in English and Spanish on a variety of health topics, or order. Your Members can call the IEHP 24-Hour Nurse Advice Line for medical advice anytime, day or night. Then, contact IEHP’s Compliance Department at (866) 355-9038 and explain the case to one of our Representatives. IEHP DualChoice & Cal MediConnect: Covered once every 12 months . IEHP does not pay Provider claims nor reimburse a Provider for a PPC, in accordance with 42 CFR Section 438.3(g) and IEHP's three-way Cal MediConnect contract. Rancho Cucamonga, CA 91729-1800. 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. You may want to ask for another form of identification in addition to the IEHP Member identification card. What does a Nutritionist do? People with Part B who meet at least one of these conditions: Have diabetes; Have kidney disease; Have had a kidney transplant in the last 36 months; People with Part B must get a referral from their doctor for the service. (800) 718-4347 (TTY), IEHP 24-Hour Nurse Advice Line (for IEHP Members only) ©2021 Inland Empire Health Plan All Rights Reserved. Sitting down with one of our doctors will help you to not only get a better sense of the necessary treatment options for your condition, but it will also give you … 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. Fax: (909) 477-8536 Contact moreinfo@optumhealtheducation.com with questions. If your benefits plan is under Greenshield or Manulife, it should be covered; however, it's typically under "Nutritional Counselling / Social Work / Counselling" and is not the same as being covered with a Registered Dietician or Registered Nutritionist… If you have questions or additional suggestions, please e-mail The IEHP Compliance Department at compliance@iehp.org. As outlined in both the APL/DPL - Reporting Requirements related to Provider Preventable Conditions, the following classify as PPCs and must be reported: Any unintended foreign object retained after surgery, A stage III or stage IV pressure ulcer that developed during the patient's stay in the hospital, A significant fall or trauma that resulted in fracture, dislocation, intracranial injury, crushing injury, burn, or electric shock, A catheter-associated urinary tract infection, Any of the following manifestations of poor glycemic control: diabetic ketoacidosis; nonketotic hyperosmolar coma; hypoglycemic coma; secondary diabetes with ketoacidosis; or secondary diabetes with hyperosmolarity, Coronary artery bypass graft (CABG) - mediastinitis, Bariatric surgery; including laparoscopic gastric bypass,gastroenterostomy, laparoscopic gastric restrictive surgery, Orthopedic procedures; including spine, neck, shoulder, elbow, Cardiac implantable electronic device procedures, Deep vein thrombosis/pulmonary embolism following total knee replacement or hip replacement, Latrogenic pneumothorax with venous catheterization, Wrong surgical or other invasive procedure performed on a patient, Surgical or other invasive procedure performed on the wrong body part, Surgical or other invasive procedure performed on the wrong patient, Add physical activity into your daily life, Improve problem-solving and coping skills, Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or. The answer while somewhat frustrating is, ‘it depends’. First, document your suspicions. Resource: website, Information on services covered by the Medicare Physician Fee Schedule (MPFS). 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 quality, cost-effective health care for lesbian, gay, bisexual, transgender, and all sexual and gender minority (LGBT) people. IEHP DualChoice & Cal MediConnect: Are covered … (888) 244-4347 The National LGBT Health Education Center is part of the Division of Education and Training at The Fenway Institute, Fenway Health. Periodically perform internal audits of billing practices and compare billing records with payments received. Misusing codes on a claim, such as upcoding and unbundling codes. Single vision lenses and frames. Inland Empire Health Plan (IEHP) expects Team Members and business entities doing business with IEHP to conduct business activities in an ethical and professional manner that promotes public trust and confidence in the integrity of IEHP. This commitment extends to our business associates and delegated entities that support IEHP’s mission to improve the delivery of quality, accessible, and wellness based healthcare services for our community. If you are considering Weight Loss Programs Covered By Iehp Health, a fitness program particularly designed for women of all ages. The Primary Care Physician (PCP) is responsible for ensuring the SHA is administered to each Member within 120 days of enrollment and may be administered as part of the Member's initial health assessment. To Enroll with IEHP (866) 294-4347 (800) 720-4347 (TTY) IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP DualChoice Member Services (877) 273-4347 (800) 718-4347 (TTY) IEHP 24-Hour Nurse Advice Line (for IEHP … A privacy breach is defined as unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which compromises the security or privacy of such information. Regular food products are not considered medical items. P.O. AHRQ Health Literacy Modules Available for Continuing Education (CE) and Maintenance of Certification (MOC) Credit. 2. E-mail: stopmedicalfraud@dhs.ca.gov. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our Members.