Ancillary
Thank you for your initial interest in becoming an Inland Empire Health Plan (IEHP) directly 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
- 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.
- Name, Title and Percentage of Ownership
5. Provider Accreditation Certificate
6. CMS/DHCS Passing Site Survey (Approval Letter)- Required for each facility
- Required for each facility
- Ancillary Providers need to successfully enroll in the State's Medi-Cal Program
- 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.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)
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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.
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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.
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What are IEHP compensation Rates?
Reimbursement rates for Behavioral Health Services are based on Medicare rates.
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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
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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
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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.
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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
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What are the benefits and limitations for Medicare DualChoice Members?
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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.
Community Supports
Community Supports are services or settings that Managed Care Plans (MCPs) may offer in place of services or settings covered under the Medicaid State Plan. These services should be medically appropriate and cost-effective alternatives.
Beginning January 1, 2022, Inland Empire Health Plan (IEHP) is offering 11 of the 14 DHCS Preapproved Community Supports services:
- Asthma Remediation
- Community Transition Services/Nursing Facility Transition to a Home
- Home Modifications
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Housing Transition Navigation Services
- Medically Supportive Food/Meals/Medically Tailored Meals
- Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care
- Recuperative Care (Medical Respite)
- Short-Term Post-Hospitalization Housing
- Sobering Centers (Riverside County)
Upcoming Services
Beginning July 1, 2023, three new Community Supports services will be offered:
- Day Habilitation
- Personal Care and Homemaker Services
- Respite Services
Please return the completed Community Supports Service Provider Assessment (PDF) via email to DGCommunitySupportTeam@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.
Hospitals
Colton, CA 92324
Barstow, CA 92311
Big Bear Lake, CA 92315
Chino, CA 91710
Needles, Ca. 92363
San Bernardino, CA 92411
Corona, CA 92882
Palm Springs, CA 92262
Victorville, CA 92395
Rancho Mirage, CA 92270
Hemet, CA 92543
Joshua Tree, CA 92252
Wildomar, CA 92595
Indio, CA 92201
Loma Linda, CA 92354
Loma Linda, CA 92354
Murrieta, CA 92563
Sun City, CA 92585
Montclair, CA 91763
Lake Arrowhead, CA 92352
Blythe, Ca 92225
Riverside, CA 92503
Pomona, CA 91767
Murrieta, CA 92562
Redlands, CA 92373
Riverside, CA 92501
Moreno Valley, CA 92555
Upland, CA 91786
Banning, CA 92220
San Bernardino, CA 92404
Apple Valley, CA 92307-2206
Temecula, CA 92592
Victorville, CA 92395
Independent Practice Associations (IPAs)
Medi-Cal
Alhambra, CA 91801
Rancho Cordova, CA 95670
Redlands, CA 92373
Los Angeles, CA 90041
San Bernardino, CA 92423
Apple Valley, CA 92307
DualChoice CalMediConnect
Apple Valley, CA 92307
Rancho Cordova, CA 95670
Redlands, CA 92374
Alliance Desert Physicians, Inc.
Beaver Medical Group
Chaffey Medical Group
FENIX Medical Group
Pinnacle Medical Group
Redlands - Yucaipa Medical Group
TriValley Medical Group
Northridge, CA 91325
Desert Oasis Healthcare
Palm Springs, CA 92262
Heritage Victor Valley Medical Group
Victorville, CA 92395
Regal Medical Group
San Bernardino, CA 92408
Ontario, CA 91764
Optum Care Network - Citrus Valley
Rancho Cucamonga, CA 91730
Optum Care Network - Corona
Corona, CA 92879
Optum Care Network - Hemet Valley
Murrieta, CA 92562
Optum Care Network - Inland Valley
Rancho Cucamonga, CA 91730
Optum Care Network - Moreno Valley
Redlands, CA 92373
Optum Care Network - Redlands
Redlands, CA 92373
Optum Care Network - Riverside
Corona, CA 92879
Optum Care Network - San Bernardino
Redlands, CA 92373
Optum Care Network - Sun City
Murrieta, CA 92562
Optum Care Network - Southwestern Valleys
Murrieta, CA 92562
Optum Care Network - Valley Physicians
Murrieta, CA 92562
Riverside, CA 92506
PCP and Specialists
Thank you for your initial interest in becoming an Inland Empire Health Plan (IEHP) directly contracted provider. Prior to extending a contract, we must receive the following documents.
Please completely fill out all required documents.
Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you.
(Adding New Provider)
- Physician Network Form (PDF)
- Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program)
- Physicians and Specialists (PDF) (M.D., D.O., D.P.M., D.C., O.D., S.P., AuD., P.T., etc)
- Pre-Contractual Letter (PDF) (Only applies to PCPs. Please review and return signed if all outlined criteria is met)
- Mid Level Practitioners (PDF) (P.A., N.P., and C.N.M.)
- Supervisor Agreement (PDF) (Only Applies to Physician Assistants)
- Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program)
- Provider Maintenance Request Form (PCP, OB/GYN, and Mid-Levels ONLY) can be found here (PDF).
- Contracts Maintenance Request Form (Specialists ONLY) can be found here (PDF).
- Individual W-9 form can be found here (PDF).
- Direct Deposit Frequently Asked Questions can be found here (PDF).
- National Plan & Provider Enumeration System (NPPES) Portal login: https://nppes.cms.hhs.gov/#/.
- NPI Address Update Instructions can be found here (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.
Provider Network Expansion Fund (NEF) Program
The purpose of the Provider Network Expansion Fund is to support the hiring of PCPs, Specialists, and Advanced Practice Providers that will serve the Medi-Cal population in the Inland Empire. Entities that hire qualified candidates are eligible to receive a subsidy up to $75,000 for Advanced Practice Providers, $100,000 for PCPs, and $150,000 for Specialists. All candidates must be a new access point in IEHP's network and not have prior history in the Inland Empire. Please take note of the following:
- The NEF Program will be targeting specific Provider types. The Provider types and corresponding regions displayed below comprise the list of positions that are currently eligible to receive a subsidy through the NEF Program.
- The funding disbursement schedule is as follows:
- 50% when the qualified candidate completes credentialing
- 25% when the candidate completes six (6) months of service
- 25% when the candidate completes one (1) year of service
Entities that are interested in receiving support through the NEF Program must submit a complete application to be considered for the funding opportunity. Completed applications and questions should be e-mailed to NEFProgram@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.
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- Family Practice
- Internal Medicine
- Pediatrics
- Cardiac/Thoracic Surgery
- General Surgery
- Genetics
- OB/GYN
- Pulmonary Medicine
- Plastic Surgery
- Psychiatry
- Urology
- Family Practice
- Internal Medicine
- Pediatrics
- Allergy and Immunology
- Cardiac/Thoracic Surgery
- Cardiology
- Dermatology
- General Surgery
- Genetics
- Neurology
- Neurosurgery
- OB/GYN
- Oncology/Hematology
- Orthopedic Surgery
- Otolaryngology
- Pain Management
- Pediatric Subspecialties
- Physical Therapy
- Podiatry
- Psychiatry
- Psychology
- Pulmonary Medicine
- Rheumatology
- Speech Therapy
- Urology
- Family Practice
- Internal Medicine
- Pediatrics
- Allergy and Immunology
- Cardiology
- General Surgery
- OB/GYN
- Pain Management
- Pediatric Surgery
- Physical Therapy
- Psychiatry
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- Allergy and Immunology
- Cardiology
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- Oncology/Hematology
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- Otolaryngology
- Pain Management
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- Pulmonary Medicine
- Rheumatology
- Family Practice
- Internal Medicine
- Pediatrics
- Allergy and Immunology
- Cardiology
- Dermatology
- Endocrinology
- Gastroenterology
- General Surgery
- Neurology
- OB/GYN
- Ophthalmology
- Otolaryngology
- Pain Management
- Physical Therapy
- Podiatry
- Psychiatry
- Pulmonary Medicine
- Speech Therapy
- Urology
- Family Practice
- Internal Medicine
- Pediatrics
- Cardiology
- Dermatology
- General Surgery
- Genetics
- OB/GYN
- Occupational Therapy
- Ophthalmology
- Pain Management
- Podiatry
- Psychiatry
- Speech Therapy
- Urology
- Family Practice
- Internal Medicine
- Pediatrics
- Allergy and Immunology
- Dermatology
- OB/GYN
- Pain Management
- Pediatric Surgery
- Psychiatry
- Pulmonary Medicine
- Family Practice
- Internal Medicine
- Pediatrics
- Genetics
- OB/GYN
- Pediatric Surgery
- Plastic Surgery
- Psychiatry
Updated May 5, 2023
Screening and Enrollment
Introduction
Per All Plan Letter (APL) 17-019, which has been superseded by APL 19-004, all Providers currently in IEHP's network and those looking to join the network are mandated to enroll in the Medi-Cal Program. This requirement to enroll in the Medi-Cal Program applies to all IEHP Providers, including those participating through an IPA. If a Provider currently active with IEHP fails or declines to complete their enrollment in the Medi-Cal Program, IEHP will be required to terminate their participation from the network.
How to Enroll
The Provider Enrollment Division (PED), a unit within the Department of Health Care Services (DHCS), is responsible for the timely enrollment of Providers into the Medi-Cal Program. PED now offers an improved web-based application via their Provider Application and Validation Enrollment (PAVE) portal. Please note the current PAVE release may not support specific Provider types or submissions from new out-of-state Providers. PAVE is being implemented in a series of releases to include Provider types and enrollment actions. Here is a current list of Provider types supported in PAVE.
Provider Resources
All Plan Letter 19-004
This APL supersedes 17-019, the APL mandating Providers to enroll in the Medi-Cal Program.
All Plan Letter 17-019
Access the APL on DHCS's website regarding the screening and enrollment of all Providers rendering services to Medi-Cal beneficiaries.
California Health & Human Services (CHHS) Agency Open Data Portal
Utilize the Open Data Portal to identify Providers who have successfully enrolled in the Medi-Cal Program through DHCS. The portal is maintained and updated by PED monthly.
Frequently Asked Questions (FAQ)
The document contains responses from DHCS to frequently asked questions regarding screening and enrollment requirements.
Provider Resources from DHCS
Access to PAVE Provider Types, PAVE 101 Training Slides, Provider Job Aides, FAQs, PAVE Support Resources
Contact Information
Department of Healthcare Services
Attn: Provider Enrollment Division MS4704
PO BOX 997412
Sacramento, CA 95899-7412
PED Message Center
(916) 323-1945
After reaching the welcome message, please select Option 4, then Option 1 to speak with a live agent.
PAVE Technical Assistance
(866) 252-1949
PAVE@dhcs.ca.gov
PED Policy Assistance
PEDCORR@dhcs.ca.gov
IEHP Provider Assistance
ProviderNetwork@iehp.org
Vision
Thank you for your initial interest in becoming an Inland Empire Health Plan (IEHP) directly contracted provider. Prior to extending a contract, we must receive the following documents.
PLEASE NOTE, IEHP is only accepting Vision Providers who meet the following exceptions through October 31, 2022:
- Providers practicing in any of the CalAIM service area expansion territories effective January 1, 2022 (including formerly voluntary and excluded zip codes)
- Providers filling positions that have been vacated in an existing practice
- Providers transitioning from an existing group agreement to their own individual agreement
- Providers being added to existing Vision groups
Please completely fill out all required documents and submit to contract@iehp.org.
Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you.
1. Vision Provider Network Participation Form (PDF)
2. Letter of Interest that outlines the following:- What Specialty/Services you are interested in contracting for
- Facility locations(s)
- National Provider Identifier (NPI) for each facility
- Medi-Cal Provider information number (PIN)
- A current Taxpayer Identification Number and Certification Form
5. Liability Insurance Certificate
- Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrance; and
- Three Million Dollars ($3,000,000) aggregate per year for professional liability
7. Ownership Information (PDF)
- Name, Title, and Percent of Ownership
Contracts Maintenance Request Form can be found here (PDF).
All 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.