Dear Valued Primary Care Providers, we kindly remind you of the following critical requirements for IHA and AWVs:

1. IHA must be performed within 90 days of enrollment or within the past 12-months for annual assessments
2. PCP office shall make reasonable attempts to contact a member and schedule an IHA. All attempts shall be documented.
3. The IHA, at a minimum, must include a physical and mental health history.
4. The Physical exam including review of all organ systems including but not limited to:
   • Height and Weight
   • BMI
   • Total Serum Cholesterol measurement
   • Clinical breast examination
   • Tuberculosis Screening: All Members will receive TB testing upon enrollment and annual screening will be part of the annual history and physical

Additionally, we have listed the Preventative services per the USPSTF A and B Guidelines for ages 65-year and older, where clinically indicated:

1. Abdominal Aortic Aneurysm Screening
2. Breast Cancer Screening (Mammograms)
3. Cardiovascular Disease Testing/Risk Reduction Visit (therapy for cardiovascular disease)
4. Colorectal Cancer Screening
5. Depression and Suicide Screening
6. HIV Screening
7. Immunizations (per CDC guidelines)
8. Obesity Screening and Counseling/Therapy to Promote Sustained Weight Loss
9. Screening and Counseling to reduce alcohol misuse
10. Hepatitis B screening
11. Hepatitis C screening
12. BRCA risk assessment and genetic counseling/testing
13. Falls prevention: older adults
14. Mental health and status evaluation
15. Social history
16. Sexual history
17. Use of alcohol, tobacco and drugs
18. Screening for Lung Cancer with low dose computed tomography (LDCT)
19. Statin preventive medication: adults ages 40–75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater
20. Bone Mass Measurement
21. Drug Use / Unhealthy Drug Use: Screening
22. Trichomonas
23. Herpes
24. Chlamydia screen for all sexually active females who are determined to be at high-risk for chlamydia infection using the most current CDC guidelines.
25. Gonorrhea screening: women
26. Sexually Transmitted Infections Counseling
27. Syphilis screening
28. Blood pressure screening: adults
29. BRCA risk assessment and genetic counseling/testing

For any questions on any of these updates, please contact the HealthSmart MSO Provider Services team at (714) 947-8600. Thank you for you continued support.

On January 1st, 2025 members who are currently Brand New Day will automatically change over to a Central Health Medicare Plan. We are sure you have many questions.

Please click the link below to access the Frequently Asked Questions.

BND Brand Transition_Provider FAQs Part II

Providers can submit their Claims or Encounter data via the Claim/Encounter button new feature of our Portal.

Annual Health Assessment Submission Feature
Providers can submit their members Initial and Annual Health Assessments for their Medicare and Commercial Members with the new button submission feature.

HEDIS GAPS Download Feature
Click on the HEDIS GAPS button and download all your member's HEDIS GAPS and get specifics how to close the Gaps in Care. Get access to the latest HEDIS Reference Guides and Coding.

04/11/2023: Medi-Cal Redetermination.

During the COVID-19 Public Health Emergency, the federal government paused Medicaid eligibility verifications. This process is known as redetermination. Roughly 13 million Medi-Cal members stayed enrolled during this time without re-certifying their eligibility. Now, the state of California is resuming this requirement, starting April 1, 2023.

Please talk with your Medi-Cal patients about taking the steps below:

• Update their contact information – Make sure their mailing address, phone number and email address are current.
• Los Angeles County members can update their information by calling the Los Angeles County Department of Public Social Services at 1-866-613-3777 (TTY) 1-800-660-4026, or by going to benefitscal.com or visit KeepMediCalCoverage.org for more information and to sign up for text or email updates on Medi-Cal renewals.
• Orange County members can update their information by calling the County of Orange Social Services Agency at 1-800-281-9799 or by going to MyBenefitsCalWIN.org
• Sign up for updates – Create or check their online account to get general updates about Medi-Cal renewals through email and text messages.
• Check their mailbox – Look out for a letter from the local county office about their Medi-Cal coverage. If they get a renewal form, fill it out and return it right away by mail, phone, in person or online.

Below are links to the CalOptima (English, Spanish, and Vietnamese) and Health Net (currently English only) member facing Flyers regarding Redetermination.

• CalOptima Redetermination-English
• CalOptima Redetermination-Spanish
• CalOptima Redetermination-Vietnamese
• Health Net Redetermination for Provider
• Health Net Redetermination for Member
• LA Care Redetermination for Providder
• Molina Redetermination - English
• Molina Redetermination - Spanish

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