Harbor:NERF: Difference between revisions

Latest revision as of 20:41, 1 May 2024

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

Authors:

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-*New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
+* As of Feb 2024, no more NERF
-*[[How to NERF]]
+** With MediCal eligibility to all Californians based on financial need, all will be assigned to a plan
-*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
+* Steps to get seen
-**Hospital presumptive eligibility (HPE) 402
+** MediCal Application - takes ~45 days to process
-***Need to go to Financial Services in 3S to complete their application for Medi-Cal,
+** Fill out '''Healthcare Options Form''' and select health plan (DHS=Molina, Healthnet, LA Care)
-***Must do so before the end of the following month.
+* A PFS person is at ED Registration Window 6 or 7 everyday 24/7
-***Only good ONCE in 12 months.
-**Fee For Service (FFS) 405 window
-***When application getting processed.
+* PVCC referral path – DHS eligible but MC pending and unassigned
-***Will get packet for them to PICK plan, or will get auto-assigned.
+** refer for anyone needing to be seen in less than 2 months
-***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
+* EWC & DC clinic - seen in-person (if needed - sometimes just coordination of paperwork) in about 2 weeks
-*** 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]]