Health assessment guidelines (Medi-Cal)
Initial Health Assessment
Completing a timely Initial Health Assessment (IHA) provides an opportunity for members to establish a relationship with their PCP. The assessment 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 members must receive an Initial Health Assessment (IHA) within 120 days of enrollment (DHCS Policy Letter 08-003). A minimum of three documented attempts must be made to schedule the IHA, including at least one phone call and one letter.
The IHA consists of but is not limited to:
- A comprehensive health history (medical, social, family)
- Physical exam, including a systems review
- The completion of the Staying Healthy Assessment
- Counseling, including Tobacco Cessation
- Medical testing and treatment
- Blood lead level
- American Academy of Pediatrics
- Bright Futures
- U.S. Preventive Services Task Force (USPSTF)
- Recommended Immunization Schedules for Persons Aged 0 through 18 years
- CHDP Periodicity Schedule for Health Assessment Requirement by Age Group
- U.S. Preventive Services Task Force (USPSTF), Adult Health Recommendations
- Recommended Adult Immunization Schedule
- Centers for Medicare and Medicaid Services
Although there is no specific form, you must complete documentation of this visit for the patient’s medical record. You must document provision of the assessment or a comparable comprehensive assessment in the patient's medical chart. You may use age-appropriate physical evaluation templates (PDF, 133 KB).
During their Initial Health Assessment, members need to complete an Individual Health Education Behavioral Assessment Tool (IHEBA) in their age category. The IHEBA can help you identify risky health behavior in order to promote positive lifestyle changes. Forms are available for download below.
In our efforts to coordinate with our providers, Blue Shield Promise conducts outreach to all new members to ensure timely IHA access. Within 120 days of enrollment, members receive phone calls and letters notifying them of this service and encouraging them to call their PCP to make an IHA appointment. Blue Shield Promise also sends a letter to the PCPs notifying them of their newly assigned members and reminding them of the requirement to conduct a timely IHA. We will follow up with the PCP to verify whether member outreach was conducted, or an effective follow-up was done.
Please be advised your office may be randomly selected to participate in the IHA Medical Record Review utilizing the IHA Audit Tool (PDF, 272 KB)
On a monthly basis, Blue Shield Promise and your contracted Medical Group/IPA sends contracted PCPs a list of new members who are due for an IHA. There are multiple ways to receive this information, such as a secure document exchange site, website portal, via secure email, or mail. Please contact your contracted Medical Group/IPA for assistance or call our Blue Shield of California Promise Health Plan Provider Services number (PDF, 129 KB).
Staying Healthy Assessment
DHCS had released the Staying Healthy Assessment guidelines via Policy Letter 13-001, "Requirements for the Staying Healthy Assessment (PDF, 204 KB)”. For implementation and documentation requirements, please view or download the following provider training presentations. DHCS expects 100% participation from all provider offices.
SHA Instruction Sheet for Provider Office (PDF, 60 KB)
Electronic SHA Format Notification Form (PDF, 150 KB)
Preventive Health Guidelines (PDF, 230 KB)
Preventive Health Guidelines - Spanish (PDF, 163 KB)
Staying Healthy Assessment forms
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.