CalViva Health Nurse Advice Line
The CalViva Health Nurse Advice Line was developed to assist members in obtaining primary care. Information is available 24 hours a day. The program is a service offered in conjunction with the primary care physician (PCP) and does not replace the PCP. According to Health Net's access-to-care standards, all PCPs must provide 24-hour telephone service for instructions, medical condition assessment and advice. The CalViva Health Medi-Cal Member Services Department coordinates member access to the CalViva Health Nurse Advice Line.
On receipt of a call, the program nurse addresses emergencies immediately by directing the member to the emergency department and assists the member in securing an ambulance, if necessary. Members needing urgent care are referred to an urgent care center if the PCP is not available. The referral record can be faxed to the emergency department or urgent care center to inform the facility of the member's condition and pending arrival.
The program nurse educates the member on the role of the PCP, assists the member in scheduling an appointment with the PCP, and gives the member information on procedures to follow until care is received from the PCP. A copy of the encounter is faxed to the PCP immediately at the close of the call.
All interaction with hospital staff, urgent care center staff and the PCP is documented. In addition, incident reports are completed when a member does not accept the program nurse's recommendations. The nurse uses a tracking mechanism to follow up on the disposition of the member and notifies the PCP and the plan of any members who require follow-up coordination.