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 Physical exam including review of all organ systems including but not limited to:

a. Height and Weight
b. BMI
c. Blood Pressure
d. General Appearance
e. Clinical breast examination
f. 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.

1. On 12-01-2025, ALL UM/Concurrent Review/Case Mgmt/Member Services/QM management services for UCI University Physicians & Surgeons will transition to the new UCI Managed Care Office. All telephonic inquiries may be made by calling Tel: (714) 509-2001.

• a. Utilization Management, Concurrent Review, and Case Management requests may be made via Fax number: 800-299-8780

2. All UCI University Physicians & Surgeons Claims should continue to be submitted via Office Ally using code UCI01 (zero one).

Effective12-1-2025: Claims may also be mailed to: UCI University Physicians & Surgeons PO Box 450, La Verne, CA 91750, or Claims Fax: 800-793-3959.