Effective January 1, 2024, the California Department of Health Care Services (DHCS) increased reimbursement rates for certain Medi-Cal covered physician services to no less than 87.5% of Medicare to advance access, quality, and equity for Medi-Cal members and promote provider participation in the Medi-Cal program.
For questions regarding TRI, please contact IEHP Provider Call Center at 909-890-2054, 1-866-223-IEHP (4347) or providerservices@iehp.org.
*Providers have the right to file a grievance regarding their TRI payment within 365 days of receipt. Please utilize the TRI Grievance PDR and submit to targetedrateincrease@iehp.org.
Additional Resources and Information:
The Medi-Cal Learning Portal provides extensive resources and a broad range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link:
By clicking on this link, you will be leaving the IEHP website.
The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system.
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This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits.
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These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.
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This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS.
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Information on services covered by the Medicare Physician Fee Schedule (MPFS).
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Provider dispute resolution process for contracted and non-contracted Providers
Provider appeals resolution process
Submit Claims To:
Clearinghouse Payer ID (Electronic Claims)
Payer ID: IEHP1
Payer ID = IECCA
IEHP Assigned P.O. Box Address (Paper Claims)
P.O. Box 4349
Rancho Cucamonga, CA 91729-4349
P.O. Box 4409
Rancho Cucamonga, CA 91729-4349
Electronic Claim Clearinghouses
Providers now have several options to submit their claims electronically to IEHP via the
clearinghouse information listed below. If you have any questions, please contact the Provider Call Center at 909-890-2054.
Office Ally – You can submit your claims and attachments to IEHP by visiting Office Ally or contact them directly at 866-575-4120 and speak with their Enrollment Department. Providers can add the claims attachment feature to their existing account by calling 1-360-975-7000 and select Option 1.
SSI - (800) 881-2739
MDX - (562) 256-3811
ClaimRemedi
Change Healthcare (Optum) - (866) 371-9066
RelayHealth
MedAssest
Emdeon - (877) 363-3666
Medavante - (609) 945-0101
TurboTar, Inc. - (888) 757-3827
XiFin, Inc. - (858) 793-5700
Waystar - (844) 583-4268
Effective June 1, 2024, for all contracted Providers, IEHP shall waive the authorization requirement for Professional Routine Behavioral Health Services rendered by a Behavioral Health provider specialty billed with the Procedure Codes listed in the reference document below:
Thank you for being a valued partner in providing high quality care to your patients. Periodically, billing codes are updated by regulatory agencies. These guidelines will provide current billing codes and specifications and should be reviewed regularly as billing guidelines may change.