Contracted Insurance Plans and Episodic Programs Accepted at NCHS

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1 Contracted Insurance Plans and Episodic Programs Accepted at FQHC CHDP/FQHC Newborn FQHC Medi- Cal (straight Medi- Cal) - eligibility is issued from the state Medi- Cal and billing is sent directly to the state Medi- Cal Medical and Dental Clinics, mental health; primary care hospital Medi- Cal Fee- For- Service (FFS) 14 Medi- Cal (straight Medi- Cal) - eligibility is issued from the state Medi- Cal and billing is sent directly to the state Medi- Cal OB- GYN Hospital only FPACT** 5 Medi- Cal PROGRAM CDP** 13 Medi- Cal PROGRAM CCS 224 Medi- Cal PROGRAM - conditions apply Care 1st Healthy San Diego Care 1st Healthy San Diego CHDP Medi- Cal HMO patient must be assigned to (eligibility is issued by the plan, and the Direct Contract / Not through SDPMG Molina Healthy San Diego Molina Healthy San Diego CHDP Medi- Cal HMO patient must be assigned to (eligibility is issued by the plan, and the CHG Healthy San Diego CHG Healthy San Diego CHDP Medi- Cal HMO - patient must be assigned to (eligibility is issued by the plan, and the Check eligibility at State Medi- Cal website, and CHG Portal *Molina AIM (the state healthy families s will term in 2013 eligibility verification for HF required) 340 Healthy Families OB- GYN Clinics - conditions apply CHDP** 4 State and County (Gateway) Dental Clinics - conditions apply Medicare NGS 292 Medicare (straight) - eligibility is issued and billing is sent directly to the federal Medicare Medicare Palmetto - USE at Grand Family Medicine and La Mision ONLY 509 Medicare (straight) - eligibility is issued and billing is sent directly to the federal Medicare Reviewed: 01/1/2014 Page 1 of 5

2 Contracted Insurance Plans and Episodic Programs Accepted at Molina Medicare Advantage (Medi- Medi only) CHG Communicare Advantage (Medi- Medi only) 552 Medicare Medi- Cal HMO 545 Medicare Medi- Cal HMO Molina Covered California Covered California Medi- Cal - check eligibility Anthem Blue Cross Covered CA Covered California; EPO Medicare Advantage (HMO) plans: Verify eligibility. Read eligibility. If patient is assigned to Medicare HMO, verify that PCP is and providers. Sharp Commercial HMO 207 Commercial HMO Plan. Check eligibility online at Sharp's website Tricare Standard Tricare Prime Tricare For Life Tricare Extra Commercial HMO (active duty, retired, families members of armed forces) - if Tricare Prime, patient must be assigned to OB- GYN Clinics (These plans are also known as TriWest plans) Blue Cross PPO plans Multiple Private, Commercial Plans Blue Cross (Anthem) Commercial HMO Check Member Claims Address to find plan # 524 Commercial HMO Blue Shield Commercial HMO 525 Commercial HMO Aetna Commercial HMO 526 Commercial HMO & OB- GYN Clinics is contracted and in- network with these plans. Co- pays apply. Consult plan details. Authorizations required for specific services. Must be assigned to PCP with clinician. Co- Pays apply. Consult plan details - authorizations for specific services required. Must be assigned to PCP with specific services required. Must be assigned to PCP with specific services required Reviewed: 01/1/2014 Page 2 of 5

3 Contracted Insurance Plans and Episodic Programs Accepted at Health Net Commercial HMO 527 Commercial HMO United Health Care West Commercial HMO 52 Commercial HMO Must be assigned to PCP with specific services required. Blue Shield Medicare HMO 530 Commercial HMO if HMO verify eligibility Blue Shield Commercial EPO 531 Commercial HMO if HMO verify eligibility Blue Shield Commercial POS 532 Commercial HMO if HMO verify eligibility Aetna Medicare Advantage 533 Medicare Commercial HMO if HMO verify eligibility Aetna Commercial POS 534 Commercial HMO if HMO verify eligibility HealthNet Medicare HMO 535 Commercial HMO if HMO verify eligibility HealthNet Commercial POS 536 Commercial HMO if HMO verify eligibility HealthNet Commercial PPO 537 Commercial HMO if HMO verify eligibility United Healthcare West POS 53 Commercial HMO if HMO verify eligibility United Healthcare West Medicare Blue Cross (Anthem) Medicare Advantage 539 Medicare Commercial HMO if HMO verify eligibility 54 Medicare Commercial HMO if HMO verify eligibility Humana Medicare HMO (SDPMG) Easy Choice Health Plan Medicare HMO (SDPMG) 559 Medicare Commercial HMO if HMO verify eligibility 557 Medicare Commercial HMO if HMO verify eligibility Reviewed: 01/1/2014 Page 3 of 5

4 Contracted Insurance Plans and Episodic Programs Accepted at accepts a wide range of s and grants that cover to cost of care, and/or subsidize the cost of care for patients CMS 19 County of San Diego Ramona Health Center and Dental ONLY - strict eligibility requirements and other conditions apply **LIHP** 521 Terminated 01/01/2014 **Replaced with Covered California Plans** Homeless ** 20 Grant : Family Health Centers Ryan White (Medical)** Dental Supplemental (Ryan White Dental) Ramona Health Center and Dental Only - strict eligibility requirements and other conditions apply Available to Ryan White patients at Oceanside, San Marcos, and Encinitas health centers. Medical and Dental Clinics - conditions apply 16, 14 County of San Diego Medical and Dental Clinics (San Marcos and Oceanside only) - conditions apply Asthma Fund - Tri- City 150 Grant Fund: pediatrics patients with diagnosed asthma conditions may be eligible for $40 per asthma visit. This payment is applied directly to patient's outstanding balance Migrant Education Program** 1 Migrant Education Program Office of Education Medical - Oceanside Clinics and Carlsbad (Peds through 1 years only), conditions apply Medical, Mental Health and Dental Clinics OB Cash Plan** 92 Perinatal Self- Pay plan Available a Women's Health Centers Only with Delivery at Tri- City and Palomar Hospitals only. Diabetes Cash Plan** 94 Diabetes Self- Pay plan Available at Oceanside- Carlsbad Health Center Only Staff Plan** 93 Employees and registered dependents Medical clinics AND Dental clinics Reviewed: 01/1/2014 Page 4 of 5

5 Contracted Insurance Plans and Episodic Programs Accepted at * Healthy Families members have transitioned to Medi- Cal HMO plans starting January Plan Name Dental Plan # Plan Type Where is it accepted? Metlife Tricare Dental (replaces United Concordia) ** When services are covered by these episodic s or Self- Pay services, use the ZZ Dummy code in E- Charge Posting (PM/ EHR) Patient s eligibility must be verified per protocol. Eligibility verification is required for every patient and every plan// episodic. Scan copies of ALL INSURNACE CARDS and have copied to patient account. Patients who seek care at clinics because they were referred by their employer. Follow these steps: (1) Review insurance plans/s to determine if and provider is contracted with the employer to receive care. (2) Did the employer send the employee for care? 553 Commercial Dental for families and dependents of Armed Forces service members (3) Is the care covered by their employer or is it the patient's responsibility? To inquire about EHS contracts and MOUs, contact Barbara Klerk X606. Update your files with this latest list of payers and s accepted at. Dental Clinics only Prudenjal Overall Dental 237 Commercial Dental PPO Dental Clinics only Metlife Dental 249 Commercial Dental PPO Dental Clinics only Aetna Dental Plan 293 Commercial Dental PPO Dental Clinics only OHI (Oral Health Inijajve)** 504 Grant Program: Council of Community Clinics Health Network Premier Dental 43 Commercial Dental PPO Dental Clinics only DENTAL CLINICS only - condijons apply Reviewed: 01/1/2014 Page 5 of 5