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

3. Liability Insurance Certificate

• 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.

4. Ownership Information (PDF)

• Name, Title and Percentage of Ownership

5. Provider Accreditation Certificate

6. CMS/DHCS Passing Site Survey (Approval Letter)

• Required for each facility

7. California State License (if applicable)

• Required for each facility

8. Urgent Care Minimum Qualifications (if applicable)

• All Ages (PDF)
• Pediatrics (PDF)

9. Medi-Cal Number

• Ancillary Providers need to successfully enroll in the State's Medi-Cal Program

10. Provider Acknowledgment of Receipt (AOR) (PDF)

• 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)

1. What is IEHP?
2. How do I contract with IEHP?
3. What are IEHP's compensation rates?
4. What are IEHP’s minimum requirements to be considered for your BH Network?
5. 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?
6. When will I hear back from IEHP after I send my contract in?
7. What services does IEHP offer online?
8. What are the benefits and limitations for Medicare DualChoice Members?
9. 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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1. 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. 

2. 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.

3. What are IEHP compensation Rates?

   Reimbursement rates for Behavioral Health Services are based on Medicare rates.

4. 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

5. 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

6. 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.

7. 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 

8. What are the benefits and limitations for Medicare DualChoice Members?

   Click here. 

9. 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.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

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 

Community Supports FAQs (PDF)

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

Independent Practice Associations (IPAs)

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.

• 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:

1. 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.  
   
   
2. 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

• NEF Program Description (PDF)
• NEF Application (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.

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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)

3. W-9 Form (PDF)

• A current Taxpayer Identification Number and Certification Form

4. California Participating Physician Application (PDF)

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

6. Facility Business License - Faculty

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.