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24-724, Continuity of Care for Medi-Cal Members

Date: 07/15/24

Find out how to request continuity of care

Physicians or other providers who have a pre-existing relationship with the member, may request continuity of care on behalf of the member. To request a continuity of care, contact the Member Services number on the back of the member ID card.

Pre-existing relationship is defined as: The member has seen an out-of-network primary care physician, specialist, or select ancillary provider, including physical therapy, occupational therapy, respiratory therapy, behavioral health treatment, and speech therapy provider for a nonemergency visit in the medical office, at least once during the 12 months prior to the date of their initial enrollment in Community Health Plan of Imperial Valley, unless otherwise specified in the All Plan Letter (APL) 23-0221(PDF).

Health Net, on behalf of Community Health Plan of Imperial Valley, will request that you provide medical records to validate a pre-existing relationship.

Continuity of care requirements

Continuity of care requirements include the provider:

  • Accepts the Plan’s contract rates or Medi-Cal fee-for-service rates;
  • Meets the Plan’s applicable professional standards and has no disqualifying quality of care issues; and
  • is a California State Plan approved provider.

An out-of-network provider should not refer the member to another out-of-network provider without authorization from the Plan. In such cases, the Plan will make the referral, if medically necessary, if we do not have an appropriate provider within our network.

Additional information

Relevant sections of provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library. 

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.

1www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2023/APL23-022.pdf

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Imperial county.



Last Updated: 07/11/2024