3.

ENROLLMENT AND ASSIGNMENT

A. Enrollment and Eligibility

APPLIES TO:

A. This policy applies to all IEHP Medi-Cal Members.

POLICY:

A. Department of Health Care Services (DHCS) Health Care Options (HCO) Unit is
responsible for enrolling and disenrolling Medi-Cal Members into IEHP.

PROCEDURES:

A. Medi-Cal Members Only:

1. A Medi-Cal recipient wishing to join IEHP completes an enrollment form, which
is then submitted to the State for confirmation of eligibility.
2. Eligible Medi-Cal recipients are enrolled into IEHP through the DHCS enrollment
contractor (Maximus) and the DHCS HCO unit.
3. HCO staff is located throughout Riverside and San Bernardino Counties at the
major County Department of Public Social Services (DPSS) sites. A HCO
Representative is available at these locations to explain to Medi-Cal recipients
their various options for health care benefits.
4. HCO is the only entity that determines the enrollment and disenrollment of Medi-
Cal recipients under the Two-Plan model. Enrollment forms are available through
HCO and at each DPSS location and may not be copied for use in a physician’s
office. The Enrollment form varies for each county.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Executive Officer Revision Date: January 1, 2008

IEHP Provider Policy and Procedure Manual 01/19 MC_03A

Medi-Cal Page 1 of 1
3. ENROLLMENT AND ASSIGNMENT

B. Medi-Cal Enrollment Process

APPLIES TO:

A. This policy applies to IEHP Medi-Cal Members.

POLICY:

A. Health Care Options (HCO) is responsible for enrolling Medi-Cal Members into managed
care plans.

PROCEDURES:

A. Approximately fifty-five (55) days prior to an individual’s effective (eligibility) date for
Medi-Cal benefits, HCO/Maximus mails pre-enrollment packets to the following
individuals:
1. New recipients whose Medi-Cal health benefits are scheduled to begin within sixty
(60) days.
2. Current Medi-Cal recipients who are fee-for-service (FFS) whose eligibility is up
for annual review of recertification. These individuals are referred to as “Re-
determinates.”
B. The pre-enrollment packet contains, among other information, an HCO Medi-Cal
enrollment form (See Attachments, “Enrollment Form – San Bernardino – English –
Medi-Cal” and “Enrollment Form – Riverside – English – Medi-Cal” in Section 3) and
IEHP’s Provider Directory. The enrollment form varies per county and there is an
English and Spanish version for each county.
C. Medi-Cal recipients, if not assigned to a Managed Medi-Cal Plan, must complete and
return the signed enrollment form to HCO. The recipient has forty-five (45) days to
select a Health Plan. Any recipient not returning a signed enrollment form who receives a
pre-enrollment packet is assigned by the State to a Managed Medi-Cal Plan.
D. Fifteen (15) days prior to the month of eligibility, the Medi-Cal recipient is sent a
confirmation letter informing the recipient that the State has accepted their selection of a
PCP and/or Health Plan or that they have been assigned to a particular Health Plan. The
recipient receives no other mailings after this point.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January 1, 2016

IEHP Provider Policy and Procedure Manual 01/19 MC_03B

Medi-Cal Page 1 of 1
3. ENROLLMENT AND ASSIGNMENT

C. Eligible Members

APPLIES TO:
A. This policy applies to all IEHP Medi-Cal Members.

POLICY:
A. Department of Health Care Services (DHCS) determines Member eligibility based on
select criteria.

B. DHCS determines aid codes for Medi-Cal Members, along with which aid codes are
eligible for Medi-Cal Managed Care.

PROCEDURES:
A. IEHP currently serves Aid Categories and Aid Codes under its Medi-Cal contract with
the State under the Two Plan and CCI Model. Please refer to the DHCS website for the
most current Aid Code Chart:

http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx

Resources & Information- Aid Code Chart (PDF)

A. Medi-Cal Newborns
1. Newborns are covered at the time of birth, and are paid under the mother’s Medi-Cal
eligibility for the month of birth and the following month, regardless of the eligibility
status on the State Automated Eligibility and Verification System (AEVS). Once
newborn has their own active number they are no longer cover under the mother.
2. IEHP strongly encourages practitioners to assist parents in applying for Medi-Cal
benefits for the newborn by initiating the enrollment process.
B. Recipients assigned an Aid Code or Aid Category not listed on the DHCS Aid Code
Chart under the Two Plan Model remain under the State’s fee-for-service system and
cannot select IEHP as their health plan.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January 1, 2019

IEHP Provider Policy and Procedure Manual 01/19 MC_03C

Medi-Cal Page 1 of 1
3. ENROLLMENT

D. IEHP Service Area

APPLIES TO:

A. This policy applies to all Medi-Cal IEHP Members.

POLICY:

A. IEHP provides health care coverage to eligible Medi-Cal enrollees in those areas of San
Bernardino and Riverside Counties for which it is licensed as an HMO.

PROCEDURES:

A. Medi-Cal Enrollment Area

IEHP is licensed to serve Medi-Cal Managed Care Members for all zip codes within
Riverside and San Bernardino Counties, excluding the following listed areas. These
excluded areas are comprised of rural and/or mountainous areas not yet approved by
regulatory agencies for service(s) provided by IEHP:
1. Riverside County Excluded Zip Codes
92225 Blythe
92226 Blythe
92239 Desert Center/Eagle Mountain
2. San Bernardino County Excluded Zip Codes

92242 Big River/Earp 92364 Nipton/Baker

92267 Parker Dam 92366 Mountain Pass
92280 Vidal/Blythe 93558 Red Mountain
92323 Cima 93562 Trona/Argus
92332 Essex 93592 Trona
92363 Needles
B. To be eligible to enroll in IEHP Programs, enrollees must reside within the covered zip
codes for Riverside or San Bernardino County and meet the Medi-Cal Program eligibility
requirements.

IEHP Provider Policy and Procedure Manual 01/19 MC_03D

Medi-Cal Page 1 of 2
3. ENROLLMENT

D. IEHP Service Area

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on File Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January1, 2017

IEHP Provider Policy and Procedure Manual 01/19 MC_03D

Medi-Cal Page 2 of 2
3. ENROLLMENT AND ASSIGNMENT

E. Primary Care Physician (PCP) Assignment

APPLIES TO:

A. This policy applies to all IEHP Medi-Cal Members; including Seniors and People with
Disabilities (SPD) and those who are eligible for Community Based Adult Services
(CBAS).

POLICY:

A. Each Medi-Cal Member enrolled with IEHP, including dual eligible beneficiaries, will be
assigned directly to a PCP or to a Safety-Net Clinic, as applicable and Hospital by the first
day of becoming eligible based on Member choice.
B. IEHP shall provide each new Member an opportunity to select a PCP.
C. IEHP will assign a PCP to all Medi-Cal and beneficiaries who do not choose one using
family relationships or random assignment utilizing an auto-assignment algorithm.
1. IEHP will also use FFS data to assign based on established relationship.
D. In rural areas where PCP coverage is limited, Members may be assigned to a PCP Nurse
Practitioner (NP). NPs in a rural area are approved to act as a PCP. PCP selection is based
on the Member choice, family relationships or random assignment utilizing an auto-
assignment algorithm.
E. IEHP allows Members to select a specialist as their PCP as long as the specialist agrees to
abide by PCP requirements.
F. Each Medi-Cal Member may request to transfer or be assigned to another PCP or Safety-
Net Clinic as applicable by calling an IEHP Member Services Representative (MSR) at
(800) 440-4347 or online via the IEHP Member web portal, in accordance to Policy 17A1,
“Primary Care Physician (PCP) Transfers - Voluntary.”
G. IEHP allows Members with an established relationship with their in-network Provider to
remain with this Provider to avoid care disruption.
H. IEHP allows the choice of traditional and safety-net Providers for Member’s PCP selection
and has procedures in place for proportionate assignment.
I. Effective August 1, 2018, IEHP allows Medi-Cal Member who currently have an assigned
Primary Care Physician at a Federally Qualified Health Center (FQHC), Rural Health
Clinic (RHC) or Indian Tribal Clinic (ITC) will be assigned directly to the clinic not to any
individual Primary Care Physician performing services on behalf of the FQHC RHC or
ITC.

PROCEDURES:

A. IEHP receives data files directly from the designated enrollment contractor, which controls
eligibility and demographic information. On a monthly and daily basis, IEHP receives an
IEHP Provider Policy and Procedure Manual 01/19 MC_03E
Medi-Cal Page 1 of 3
3. ENROLLMENT AND ASSIGNMENT

E. Primary Care Physician (PCP) Assignment

eligibility file from DHCS containing newly enrolled and updated IEHP Medi-Cal Member
information.
B. IEHP processes this information and assigns a PCP or to a Safety-Net clinic, as applicable
to each Member based on the following:
1. Member Choice/Enrollment Forms - IEHP assigns Members to those PCPs that
Members have selected as reported by the designated enrollment contractor.
2. Member Choice/IEHP Contact - IEHP assigns Members to those PCPs or Safety-
Net Clinics, as applicable that they have requested through contact with an IEHP
representative.
a. IEHP shall provide each new Member an opportunity to select a PCP or Safety-
Net clinic as applicable within the first thirty (30) calendar days of enrollment.
3. Family Links - For Members received from the enrollment contractor that have not
selected a PCP, the IEHP data system looks to see if any family member of the
Member is currently assigned to a PCP. If a relationship is identified, the IEHP
data system assigns the new Member to the same PCP as the family member(s)
provided the specialty type is appropriate to the age and gender of the Member.
4. Auto Assignment - Members who have not been assigned a PCP through the above
mechanism are assigned a PCP or Safety-Net Clinics, as applicable using the IEHP
Auto Assignment Process. The Auto Assignment process is a computer generated
program that assigns Members to PCPs or Safety-Net Clinics, as applicable by
comparing PCP and Member demographics:
a. residence/geography
b. age
c. gender
d. language
e. enrollment limits
5. Manual Assignment - Enrollment & Eligibility representative selects a Provider for
Members using internal system Provider search. This Provider search locates a
Provider for the Member based upon the Members’ geographical location as well
as age.
C. Members are allowed to change PCPs or Safety-Net Clinic, as applicable each month.
IEHP Members can call IEHP Member Services to facilitate a PCP change. See Section
17, “Member Transfers and Disenrollment,” for more information.

REFERENCE:

IEHP Provider Policy and Procedure Manual 01/19 MC_03E

Medi-Cal Page 2 of 3
3. ENROLLMENT AND ASSIGNMENT

E. Primary Care Physician (PCP) Assignment

A. California Assembly Bill (AB) No. 2674.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January 1, 2018

IEHP Provider Policy and Procedure Manual 01/19 MC_03E

Medi-Cal Page 3 of 3
3. ENROLLMENT AND ASSIGNMENT

F. Member Identification Cards

APPLIES TO:

A. This policy applies to all IEHP Medi-Cal Members.

POLICY:

A. All Members will be mailed an IEHP identification card within seven (7) calendar days
of enrollment effective date.

PROCEDURES:

A. IEHP ID Card:
1. Each Member receives an IEHP identification (ID) card within seven (7) calendar
days of the effective date of coverage. The card contains the PCP name or Clinic
if applicable, PCP effective date, PCP office telephone number, IPA (Medical
Group) assigned to Member, Hospital assigned to Member, Doctor unique
number assigned to PCP, general co-payment information, IEHP Member
Services telephone number, and 24-Hour Nurse Advice Line telephone number,
(See Attachment, “IEHP ID Card – Medi-Cal” in Section 3).
a. IEHP Member Identification Cards are yellow.
b. Medi-Cal Open Access Identification Cards have “Open Access” listed as
their PCP Name and Hospital.
c. IEHP Medicare-Medi-Cal Identification Cards are titled “Medi-
Cal/Medicare.”
2. The IEHP ID card does not guarantee eligibility; therefore it is important that
Providers verify eligibility as outlined in Policy 4B, “Eligibility Verification
Methods.”
3. Temporary IEHP ID Card:
a. A temporary IEHP Member ID Card is available for practitioners to print
through the IEHP website at www.iehp.org.
b. Temporary IEHP ID Cards are printed with an expiration date of the last
day of the current month.
c. The IEHP ID card does not guarantee eligibility; therefore it is important
that Providers verify eligibility as outlined in Policy 4B, “Eligibility
Verification Methods.”
d. Members are able to access the temporary ID card via the secure Member
Portal at www.iehp.org. If the Member presents the temporary ID card via
a mobile device such as a tablet or phone, IEHP requests that the

IEHP Provider Policy and Procedure Manual 01/19 MC_03F

Medi-Cal Page 1 of 2
3. ENROLLMENT AND ASSIGNMENT

F. Member Identification Cards

temporary ID card viewed through the mobile device be acknowledged as

valid in compliance with the specifications listed above.
B. Medi-Cal BIC Card:
1. In addition to the IEHP ID Card, Medi-Cal Members continue to receive a Benefit
Identification Card (BIC) from the State. The BIC only contains beneficiary
identification information and does not guarantee eligibility (See Attachment,
“BIC Card” in Section 3). Members should carry both IEHP and Medi-Cal ID
cards.
C. Practitioners are encouraged to verify Member’s identification through a secondary
means, such as a Driver License or state identification card with both a picture and
signature, when presented with an IEHP ID Card. This should be used as a precautionary
measure to protect against fraud and abuse of the Member’s ID card.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January 1, 2019

IEHP Provider Policy and Procedure Manual 01/19 MC_03F

Medi-Cal Page 2 of 2
3. ENROLLMENT AND ASSIGNMENT

G. Post Enrollment Kit

APPLIES TO:

A. This policy applies to all IEHP Medi-Cal Members.

POLICY:

A. All Medi-Cal Members receive a Post Enrollment Kit.

PROCEDURES:

A. Post-enrollment materials are items sent to new IEHP Members within seven (7) calendar
days of their effective date with IEHP.

B. Post-enrollment kits are mailed monthly to Members following enrollment confirmation.

C. The materials included in the post-enrollment kits are as follows:

Contents MC OA

Welcome to IEHP Letter  

IEHP MC Member Handbook or IEHP Quick Guide  

Health Information Form (HIF/MET) 

Getting Care After Hours Magnet  

What To Do When You Need Care After Hours Brochure  

Non-Discrimination Disclaimer  

Privacy Notice  

D. All materials included in the Post-Enrollment kits do not have any statements that may
demonstrate enrollment is necessary to obtain or avoid losing Medi-Cal eligibility.

INLAND EMPIRE HEALTH PLAN

Chief Approval: Signature on file Original Effective Date: September 1, 1996

Chief Title: Chief Network Officer Revision Date: January 1, 2019

IEHP Provider Policy and Procedure Manual 01/19 MC_03G

Medi-Cal Page 1 of 1
3. ENROLLMENT AND ASSIGNMENT

Attachments

DESCRIPTION POLICY CROSS

REFERENCE

BIC Card 3F
Contracted IEHP Providers
Enrollment Form – Riverside – English – Medi-Cal 3B
Enrollment Form – SB – English – Medi-Cal 3B
IEHP ID Card - Medi-Cal 3F
State Enrollment Form Guidelines - Medi-Cal

IEHP Provider Policy and Procedure Manual 01/19 MC_03

Medi-Cal Page 1 of 1
 Attachment 03 - BIC Card

Plastic Benefits
Identification Card (BIC)
 Attachment 03 - Contracted IEHP Providers

IPA NAME IPA CODE IPA NAME IPA CODE

Alpha Care Medical Group 00A Alliance Desert Physicians, Inc. * 06U
Dignity Health Medical Foundation 00B Chaffey Medical Group * 07U
LaSalle Medical Associates 00E FENIX Medical Group* 08U

Inland Faculty Medical Group 00F Heritage Medical * 01H

IEHP Direct JJJ Regal Medical Group * 02H
Physicians Health Network 00N Desert Oasis Healthcare * 03H
Allied Pacific IPA 01P Heritage Victor Valley Medical Group * 04H
Kaiser – Fontana & Riverside 00X Pomona Valley Medical Group, Inc. * 01G
Horizon Valley Medical Group 01T Dignity Health Physician Network-IE * 01W
PrimeCare Medical Network * 01S
PrimeCare of Sun City * 02S
PrimeCare Medical of Chino Valley * 03S
PrimeCare of Corona * 04S
PrimeCare of Inland Valley * 06S
PrimeCare of San Bernardino * 07S
PrimeCare of Moreno Valley * 08S
PrimeCare of Riverside * 09S
PrimeCare of Hemet Valley * 10S
Valley Physicians Network* 11S
PrimeCare of Citrus Valley * 12S
PrimeCare of Redlands * 13S
PrimeCare of Temecula * 14S
CPN – Horizon Valley Medical Group * 01Y
Riverside Medical Clinic * 02R
San Bernardino Medical Group * 0SB
EPIC Health Plan * 01U
Beaver Medical Group * 02U
Redlands-Yucaipa Medical Group * 03U
TriValley Medical Group * 04U
Pinnacle Medical Group * 05U

Revised Date: 01/01/2019 * IPAs with Medicare link

Department: Provider Services
 Attachment 03 - Contracted IEHP Providers

HOSPITAL NAME HOSP HOSPITAL NAME HOSP

CODE CODE
Chino Valley Medical Center 01 Kaiser Foundation Hospital MVH 39
Community Hospital of San Bernardino 02 Network Access as Directed by Your Doctor 88
Corona Regional Medical Center 03 Children’s Hospital of Orange County 1953
Desert Regional Medical Center 04 Children’s Hospital at Mission 6475
Desert Valley Hospital 05 Bear Valley Hospital 7791
Hemet Valley Medical Center 06 USC Norris Cancer Hospital 12403
John F. Kennedy Memorial Hospital 07 Keck Hospital of USC 16733
Loma Linda University Medical Center 08 Loma Linda University Medical Center - 17084
Murrieta
Menifee Valley Medical Center 09 Temecula Valley Hospital 31499
Redlands Community Hospital 11
Riverside University Health Care System 12
San Antonio Community Hospital 13
Arrowhead Regional Medical Center 14
San Gorgonio Memorial Hospital 15
Rancho Springs Medical Center 16
St. Bernardine Medical Center 17
St. Mary Medical Center 18
Victor Valley Global Medical Center 20
Kaiser Fontana/Riverside 22
Pomona Valley Hospital Medical Center 23
Parkview Community Hospital Med. Center 24
Riverside Community Hospital 25
Montclair Hospital Medical Center 26
Barstow Community Hospital 27
Inland Valley Regional Medical Center 28
Mountains Community Hospital 29
Eisenhower Medical Center 31
Hi Desert Medical Center 32
CHSB (IEHP-Direct)/LaSalle) 33
Loma Linda University Children Hospital 40

Revised Date: 01/01/2019 * IPAs with Medicare link

Department: Provider Services
 Attachment 03 - Enrollment Form - Riverside - English - Medi-Cal
Reset Print

Highly Confidential
RS_0MM3452_ENG_0707
 Attachment 03 - Enrollment Form - SB - English - Medi-Cal
Reset Print

Highly Confidential
SB_0MM3452_ENG_0707
 Attachment 03 - IEHP ID Card - Medi-Cal

IEHP ID Card – Medi-Cal

 
11
1 
12
2 
4  3 
5  8  
6 
7 

10 

1. Member Name – First Name, Last Name

2. Member ID # - Unique IEHP Assigned #
3. PCP Effective Date – mm/dd/yyyy
4. Doctor Name – First Name, Last Name of assigned PC
5. Phone – PCP’s phone number
6. Medical Group – IPA (Medical Group) assigned to Member
7. Hospital – Primary Hospital assigned to Member
8. Doctor # - Unique # assigned to PCP
9. Phone – PCP’s phone number
10. Co-pay amounts: Medi-Cal Members have zero ($0) co-pay.
11. 800 Number for IEHP Member Services
12. Nurse Advice Line Phone Number

 
 Attachment 03 - State Enrollment Form Guidelines - Medi-Cal

State Enrollment Form (9518603002)

Guidelines
Attached are copies of the new State Enrollment Forms. Enrollment forms for
Riverside and San Bernardino counties are different. There is an English and
Spanish version for each county. DHS calls these forms Medi-Cal Choice
Enrollment/Disenrollment Forms. The following are the key fields that must be
filled out for enrollment or disenrollment for the form to be accepted by DHS.

1. As the Medi-Cal Beneficiary, you must fill out the blocks for yourself and any
of your dependents.

2. As the Medi-Cal Beneficiary, you must sign the form at the bottom of the
page. If it is a minor, the minor and the adult of the household must both sign
the form. Infants are excluded.

3. As the Medi-Cal Beneficiary, you must fill out:

 Case Name (Head of Household Information)
 Enter your Health Plan Choice. Inland Empire Health Plan would be
code 305 for Riverside County or code 306 for San Bernardino County.
 Enter the Doctor number you want. The Doctor number can be found
inside of the Provider Directory next to the Doctor’s name.
 If you or any of the dependents are pregnant, make sure Section 6a is
filled out.
 Make sure you sign your signature at the bottom of the form.

If you have questions about IEHP, call the IEHP Member Services Department at
1-800-440-4347.