ALL Members should have IHA within first 120 days of HPSJ Enrollment

It is important for newly enrolled HPSJ members to receive an Initial Health Assessment (IHA). This ensures that members are comprehensively assessed for acute, chronic and preventive health care needs, and it supports the development of a new provider/patient relationship. During the first examination, physicians and providers may also identify members whose health needs require coordination with community resources from other agencies.

HPSJ offers a $25 incentive to the provider for each member to receive an IHA within 120 days of HPSJ enrollment. This provider incentive is based on claims/encounters received from both fee for service or capitated providers.

Based on HPSJ’s contract with the Department of Health Care Services (DHCS), physicians and providers are responsible for ensuring that newly enrolled HPSJ members receive an IHA as described in Title 22 CCR Section 53851(b),(1), 53902(m), and 53910.5(a)(1) :

• All newly enrolled members must have a complete IHA within 120 days of enrollment
• Members who have changed their PCP within the first 120 days of enrollment and the IHA was not yet completed

Please log-on to the online provider portal, Doctors Referral Express (DRE), to access your Member Roster to view newly enrolled members that are assigned to your practice/clinic. You can identify the member’s enrollment date (which may precede their eligibility date with your practice) to determine how quickly they’re nearing the 120 day IHA deadline.

There are three exceptions to the 120 day requirement:

1. If all elements of the IHA were completed within 12 months prior to the member’s effective date of enrollment. (If the member’s current PCP was not the physician who performed this IHA, the current PCP must document in the member’s medical record that the findings have been reviewed and updated accordingly.)
2. If the new member choses their current PCP, however, a physical exam should be documented within 12 months of enrollment.
3. The last exception can be made if the member does not stay continuously enrolled for the first 120 days.

One of the following CPT and ICD-10 codes are suggested for IHA billing (and should be billed when an IHA is performed):

If you have questions, please contact our Provider Services Department at 209-942-6340.