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Manuals & Training

Manuals

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Provider Manuals

Review and understand how IEHP functions by knowing the rules and regulations we must comply by, as governed by various agencies

Summary of Changes

Manuals & Trainings

Provider Manuals: Medi-Cal, IEHP DualChoice (HMO D-SNP), IEHP Covered (CCA), and EDI

"Access IEHP Provider and Procedure Manuals using the online policy search - SAI360"

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The Provider manual outlines and documents the procedures, protocols, and standards of care in relation to the Medi-Cal, IEHP DualChoice (HMO D-SNP), and IEHP Covered Plan.

 

The manual documents the procedures, protocols and formats for electronic data exchange between IEHP and its contracted Providers related to Member eligibility, encounter data, bed-day reporting, capitation reports and electronic claims submissions.

 

The EDI manual documents the processing schedules, file formats, procedures and narrative information that is necessary for Providers to understand and conduct electronic data exchange that is HIPAA compliant which is required under the IEHP Agreement.

Benefit Manual Information

These Benefit Manuals are offered as guidelines to determine benefit eligibility and are not intended to be construed as or to serve as a standard of medical care, or as a contractual agreement for payment. Standards of medical care are determined on the basis of all facts and circumstances for each individual case.

 

 

If a benefit question is not addressed in the Benefit Manual, please contact IEHP at (909) 890-2000 for further information.

 

IPA Delegation Agreement

The purpose of the IPA Delegation Agreement is to specify the activities delegated by Inland Empire Health Plan (IEHP) under the Delegation Agreement with respect to:

 

  1. Quality Management and Improvement
  2. Continuity and Coordination of Care
  3. Utilization Management
  4. Care Management 
  5. Credentialing and Recredentialing 
  6. Encounter Data
  7. Claims Adjudication

 

Please visit the Delegation Oversight section of the Forms page to access copies of the IPA Delegation Agreement (Medi-Cal and IEHP DualChoice).

Acknowledgement of Receipt

The Delegate or Provider has the responsibility to ensure review, understanding, and attestation of the information contained in the Manual. One of the reasons providers have to sign an acknowledgment of receipt at IEHP is to confirm that they have received important documents, such as notifications, policy updates, or other communications from the health plan.

Submit Online

Submit your AOR electronically with your unique access code from your email or letter.

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2025 Acknowledgement of Receipt

Training

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Training

IEHP has a variety of trainings in different subjects to learn and grow as a provider. 

IEHP DualChoice (HMO D-SNP) Model of Care Training

This e-Course is designed to educate all in-network Providers of the healthcare plan’s Model of Care for IEHP D-SNP Members.

 

Regulatory  E-course

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Diversity, Equity and Inclusion Training

This e-Course is designed to educate all in-network Providers on the cultural diversity of IEHP Members and to raise awareness of the IEHP cultural and linguistic policies and resources. 

 

Regulatory  E-course

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Medi-Cal for Kids and Teens 

Explore the Department of Health Care Services’ training resources that help to strengthen understanding among Providers and bring awareness of the medically necessary services given to children and young adults enrolled in Medi-Cal.

 

Regulatory  PDF

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Compliance Training (FWA, HIPAA Privacy and Security)

The IEHP FWA, HIPAA Privacy and Security training focuses on the elements of our compliance program, conduct and ethics standards, and other fraud, waste, abuse and privacy topics. 

 

Regulatory  PDF

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