Harbor:NERF: Difference between revisions
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*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. | ||
** | **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 | |||
***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. | |||
**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 | ***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]] | ||
Revision as of 21:40, 15 October 2021
- 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.
- 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.
- 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
- 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
- Hospital presumptive eligibility (HPE) 402
- 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.
- 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