Initial Health Appointment Guidelines (Medi-Cal)
Initial Health Appointment
Completing a timely Initial Health Appointment (IHA) provides an opportunity for members to establish a relationship with their primary care physician (PCP). In addition, the appointment allows members to obtain necessary health care and preventive services, which can lead to positive health outcomes and improvement in their overall health status.
All newly enrolled Blue Shield Promise Medi-Cal plan members must receive an IHA within 120 days of enrollment, as required by (APL 22-030). A minimum of two documented attempts must be made to schedule the IHA, including at least one phone call and one letter to the member.
The IHA includes, but is not limited to:
• A comprehensive health history (medical, social, family)
• Physical exam, including a systems review
• Medical testing and treatment
• Health screening for common diseases
• Referrals for follow-up care
Beginning January 1, 2023, the completion of an Individual Health Education Behavioral Assessment (IHEBA), also known as an SHA (Staying Healthy Assessment form), will no longer be required as part of the IHA visit.
Blue Shield Promise is dedicated to supporting your efforts in this area. We have created an interactive tool listing IHA requirements for compliance, including a downloadable list of recommended codes for accurately documenting the IHA, and links to more resources. We encourage you to click the link below to review the training module and learn more details.
Initial Health Appointment for Medi-Cal Members Training
Required provider documentation of the IHA
Although there is no specific form to use, your practice is required to document provision of the IHA, or a comparable comprehensive assessment, in the patient's medical chart. You may use age-appropriate physical evaluation templates (PDF, 133 KB) to complete the documentation.
In our efforts to coordinate with and support our Medi-Cal network providers, Blue Shield Promise conducts outreach to all new Medi-Cal members to ensure timely access to completing an IHA. Within 120 days of enrollment, members receive phone calls and new member welcome packet notifying them of this service and encouraging them to call their PCP to schedule their IHA.
We also perform outreach to our network providers to help support timely IHAs by randomly selecting practices to participate in Blue Shield Promise’s IHA Medical Record Review. For this process, we randomly select an office and ask for records (IHAs), then review and provide feedback on those submissions, using our IHA Audit Tool as a guide. To learn about the types of information we may discuss with you, we encourage you to review our IHA Audit Tool.
In addition, each month Blue Shield Promise and the IPA/medical groups that provide Medi-Cal services for Blue Shield Promise members send to their contracted PCPs a list of new Medi-Cal members who are due to receive an IHA. There are multiple ways the PCPs may receive this information, such as a secure file transfer protocol (SFTP) site, website portal, secure email, or postal mail. Please contact each of the IPA/medical groups with whom your practice is contracted to provide Medi-Cal services for Blue Shield Promise members to ensure you are receiving the list by the method most beneficial to your practice.
If you have any questions about providing services or submitting claims for these members, you may also contact Blue Shield Promise Provider
Services via Live Chat after logging in at blueshieldca.com/provider or by telephone at (800) 468-9935, Monday through Friday, 6:00 a.m. to 6:30 p.m.
• All Plan Letter 22-030 (DHCS APL 22-030)
• AAP/Bright Futures Periodicity Schedule
• Advisory Committee on Immunization Practices ACIP Guidelines
• USPSTF Recommendations
Review and download provider manuals for Cal MediConnect and Medi-Cal policies.
Access to care standards
Learn the guidelines Blue Shield of California Promise Health Plan uses to ensure our members have proper access to care.
Nursing Facilities Reference Guide
Learn about the requirements for Blue Shield Promise's provider network nursing facilities.
Physician’s facility site review policy and procedures
See policies for site accessibility, fire safety and prevention, non-medical emergency procedures, medical equipment maintenance, and staff qualification requirements.
Medical record documentation standards
Learn about the requirements and standards for Blue Shield Promise member medical records.
Provider dispute resolution policy and procedures
Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.
Fraud prevention guidelines
Learn how to report suspected healthcare fraud and find prevention tips and guidelines.
Find the forms you need for authorizations, referrals, service requests, EFT enrollment, and provider disputes.