Harbor:NERF - Revision history

Bchap23 at 20:41, 1 May 2024

2024-05-01T20:41:09Z

← Older revision		Revision as of 20:41, 1 May 2024
Line 15:		Line 15:
	* EWC & DC clinic - seen in-person (if needed - sometimes just coordination of paperwork) in about 2 weeks		* EWC & DC clinic - seen in-person (if needed - sometimes just coordination of paperwork) in about 2 weeks









	~~'''OLD INFORMATION'''~~
	*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
	*[[How to NERF]]
	*Prioritize for patients actually need PCP, not for routine PCP follow up
	*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.
	*DO NOT NERF patient with MHLA or has non-DHS Medi-Cal managed care.
	**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.
	**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.

	*Time frame to empanelment depends on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d
	*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is
	**Hospital presumptive eligibility (HPE) 402
	***Need to go to Financial Services in 3S to complete their application for Medi-Cal,
	***Must do so before the end of the following month.
	***Only good ONCE in 12 months.
	**Fee For Service (FFS) 405 window
	***When application getting processed.
	***Will get packet for them to PICK plan, or will get auto-assigned.
	***Might start out DHS but then turned into OOP later.
	**Restricted 406 for patients
	*** Don't qualify for a plan due to residency challenges, or self pay
	*** CAN GET NERF'd quickly
	*Ask Registration if you have any questions on shift
	*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.
	*[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
	*[[Insurance Codes]]

	[[Category:Admin]]		[[Category:Admin]]

Bchap23 at 22:57, 13 February 2024

2024-02-13T22:57:14Z

← Older revision		Revision as of 22:57, 13 February 2024
Line 1:		Line 1:
			* As of Feb 2024, no more NERF
			** With MediCal eligibility to all Californians based on financial need, all will be assigned to a plan


			* Steps to get seen
			** MediCal Application - takes ~45 days to process
			** Fill out '''Healthcare Options Form''' and select health plan (DHS=Molina, Healthnet, LA Care)
			* A PFS person is at ED Registration Window 6 or 7 everyday 24/7


			* PVCC referral path – DHS eligible but MC pending and unassigned
			** refer for anyone needing to be seen in less than 2 months


			* EWC & DC clinic - seen in-person (if needed - sometimes just coordination of paperwork) in about 2 weeks









			'''OLD INFORMATION'''
	*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP		*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
	*[[How to NERF]]		*[[How to NERF]]

Rossdonaldson1 at 10:21, 23 October 2021

2021-10-23T10:21:03Z

← Older revision		Revision as of 10:21, 23 October 2021
Line 24:		Line 24:
	*[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).		*[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
	*[[Insurance Codes]]		*[[Insurance Codes]]

			[[Category:Admin]]

Rossdonaldson1: Rossdonaldson1 moved page NERF to Harbor:NERF

2021-10-23T10:20:42Z

Rossdonaldson1 moved page NERF to Harbor:NERF

← Older revision	Revision as of 10:20, 23 October 2021
(No difference)

Andreawu at 22:49, 15 October 2021

2021-10-15T22:49:54Z

← Older revision		Revision as of 22:49, 15 October 2021
Line 1:		Line 1:
	*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP		*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
			*[[How to NERF]]
	*Prioritize for patients actually need PCP, not for routine PCP follow up		*Prioritize for patients actually need PCP, not for routine PCP follow up
	*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.		*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.

Andreawu at 22:45, 15 October 2021

2021-10-15T22:45:14Z

← Older revision		Revision as of 22:45, 15 October 2021
Line 21:		Line 21:
	*Ask Registration if you have any questions on shift		*Ask Registration if you have any questions on shift
	*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.		*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.
	*[[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)]] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).		*[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
	*[[Insurance Codes]]		*[[Insurance Codes]]

Andreawu at 22:44, 15 October 2021

2021-10-15T22:44:44Z

← Older revision		Revision as of 22:44, 15 October 2021
Line 21:		Line 21:
	*Ask Registration if you have any questions on shift		*Ask Registration if you have any questions on shift
	*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.		*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.
	*Continuity Care Clinic (CCC) ~~[insert link~~] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).		*[[https://wikem.org/wiki/Template:CCC\|Continuity Care Clinic (CCC)]] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
	*[[Insurance Codes]]		*[[Insurance Codes]]

Andreawu at 21:44, 15 October 2021

2021-10-15T21:44:17Z

← Older revision		Revision as of 21:44, 15 October 2021
Line 1:		Line 1:
	*New Empanelment Referral Form (NERF) ~~time frame varies depending on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d~~		*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
			*Prioritize for patients actually need PCP, not for routine PCP follow up
	*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.		*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.
	*DO NOT NERF patient with MHLA or has non-DHS Medi-Cal managed care.		*DO NOT NERF patient with MHLA or has non-DHS Medi-Cal managed care.
	**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.		**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.
	**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.		**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.

			*Time frame to empanelment depends on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d
	*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is		*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is
	**Hospital presumptive eligibility (HPE) 402		**Hospital presumptive eligibility (HPE) 402

Andreawu at 21:42, 15 October 2021

2021-10-15T21:42:09Z

Andreawu at 21:40, 15 October 2021

2021-10-15T21:40:24Z

← Older revision		Revision as of 21:40, 15 October 2021
Line 3:		Line 3:
	*A NERF is not needed for a patient who already has MHLA or has non-DHS Medi-Cal managed care.		*A NERF is not needed for a patient who already has MHLA or has non-DHS Medi-Cal managed care.
	**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.		**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.
	**~~Please use~~ the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.		**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.
	*'''Patient Relations Rm 1-B-1''', x64400 during business hours is great resource for patients to get PCP and navigate insurance (Out of Plan or Out of County, wants to switch to DHS)		*'''Patient Relations Rm 1-B-1''', x64400 during business hours is great resource for patients to get PCP and navigate insurance (Out of Plan or Out of County, wants to switch to DHS)
	*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is		*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is
	*		**Hospital presumptive eligibility (HPE) 402
	~~<gallery>~~		***need to go to Financial Services in 3S to complete their application for Medi-Cal,
	~~Continuum of MediCal.png\|Continuum of MediCal~~		***must do so before the end of the following month.
	~~</gallery>~~		***Only good ONCE in 12 months.
	**Hospital presumptive eligibility (HPE) 402 need to go to Financial Services in 3S to complete their application for Medi-Cal, must do so before the end of the following month. Only good ONCE in 12 months.		**Fee For Service (FFS) 405 window
	**Fee For Service (FFS) 405 window when application getting processed. Will get packet for them to PICK plan, or will get auto-assigned. Might start out DHS but then turned into OOP later.		***when application getting processed.
	**Restricted 406 for patients ~~that~~ don't qualify for a plan due to residency challenges, or self pay ~~-->~~ CAN GET NERF'd quickly		***Will get packet for them to PICK plan, or will get auto-assigned.
			***Might start out DHS but then turned into OOP later.
			**Restricted 406 for patients
			*** don't qualify for a plan due to residency challenges, or self pay
			*** CAN GET NERF'd quickly
	*Ask Registration if you have any questions on shift		*Ask Registration if you have any questions on shift
	*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.		*Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.
	*Continuity Care Clinic (CCC) [insert link] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).		*Continuity Care Clinic (CCC) [insert link] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
	*[[Insurance Codes]]		*[[Insurance Codes]]

← Older revision		Revision as of 21:42, 15 October 2021
Line 1:		Line 1:
	*New Empanelment Referral Form (NERF) time frame varies depending on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d		*New Empanelment Referral Form (NERF) time frame varies depending on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d
	*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.		*Before NERF’ing, ensure that the patient '''wants a PCP within DHS''' and has '''given their preferred phone number'''.
	*A NERF ~~is not needed for a~~ patient ~~who already has~~ MHLA or has non-DHS Medi-Cal managed care.		*DO NOT NERF patient with MHLA or has non-DHS Medi-Cal managed care.
	**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.		**If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.
	**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.		**Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.
	*'''Patient Relations Rm 1-B-1''', x64400 during business hours is great resource for patients to get PCP and navigate insurance (Out of Plan or Out of County, wants to switch to DHS)
	*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is		*Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is
	**Hospital presumptive eligibility (HPE) 402		**Hospital presumptive eligibility (HPE) 402
	***~~need~~ to go to Financial Services in 3S to complete their application for Medi-Cal,		***Need to go to Financial Services in 3S to complete their application for Medi-Cal,
	***~~must~~ do so before the end of the following month.		***Must do so before the end of the following month.
	***Only good ONCE in 12 months.		***Only good ONCE in 12 months.
	**Fee For Service (FFS) 405 window		**Fee For Service (FFS) 405 window
	***~~when~~ application getting processed.		***When application getting processed.
	***Will get packet for them to PICK plan, or will get auto-assigned.		***Will get packet for them to PICK plan, or will get auto-assigned.
	***Might start out DHS but then turned into OOP later.		***Might start out DHS but then turned into OOP later.
	**Restricted 406 for patients		**Restricted 406 for patients
	*** ~~don~~'t qualify for a plan due to residency challenges, or self pay		*** Don't qualify for a plan due to residency challenges, or self pay
	*** CAN GET NERF'd quickly		*** CAN GET NERF'd quickly
	*Ask Registration if you have any questions on shift		*Ask Registration if you have any questions on shift