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communication or updates from CCHP, access to care or services,
scheduling issues
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Please share any additional comments or suggestions for improving future meetings
Responses includes:
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More availability near my address for certain appointments
How to enroll in CCHP and choose a primary care physician
Information on enrollment and PCP selection will be provided
4.
Provider Network Development and Assessment
Fabiola Quintero (FQ) was introduced as presenter. She will be discussing how her department is working to
increase the Plan’s providers
FQ asked the question “What is a provider network?” - participant answered that it was list of providers found
online and can be searched for available providers. FQ goes on to describe they types of providers listed such as
PCP, Specialists, Hospitals, Skill Nursing, and Durable Medical Equipment companies that are contracted with
CCHP to provide services to the members. Karina inquired about whether members are given a provider directory,
BT confirmed that the new member packet including a provider directory.
“What is Network Development?” Answer: Recruitment of Providers that are needed to meet Member needs in a
timely manner. Surveys are sent to members to ensure that CCHP is addressing any gaps and give staff a better
idea of what type of providers are needed to meet the needs of members.
What is assessment is based on? An assessment is a review of current in-network providers to determine if
member needs are being met for access and availability. Based on the following:
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Member Surveys
Member Grievances and Appeals
Secret Shopper Calls
Availability of appointments within a reasonable time
Providers Accepting new Members
Time and distance standard from members home to a provider’s office
Number of Providers available to deliver care per member
FQ shares that members can share their concerns/issues with accessing care and additionally, members can
indicate the providers they would like to see in the network. FQ provides the Provider Relations contact
number and email address.
5.
Transportation Services
CL provides some general information regarding transportation services. Do you know?
· Transportation service is a CCHP covered benefit
· Types of transportation CCHP offers
· How to request transportation services
Two types of transportation:
· Non-Medical Transportation (NMT) rides (bus, paratransit, car or taxi) to medical appointment or Medi-Cal
covered service. If member can get in and out of vehicle by themself then use NMT; otherwise need to
obtain order for NEMT
· Non-Emergency Medical Transportation (NEMT) - rides by (ambulance, wheelchair, van, litter/gurney or
air transportation) provided when member needs prohibit transport by methods listed in NMT - NEMT
must be ordered by healthcare provider
Limitation: transportation must be covered by Medi-Cal and is the lowest cost transport to meet member
need to the closest provider from home where there is available appointment
CL provides an example using a ride to a pharmacy. If one lives in Pittsburg; then pharmacy should be in Pittsburg
However, if one has access to an out-of-area contracted facility (e.g., UCSF) then services can be covered
Transportation is the best transport that is needed. Staff is directed to pay attention to details. If services are
medically necessary for facilities (e.g., UC-Davis) then one should obtain an order from provider stating that
members need to go out of area.
CL goes over the guidelines for ordering transportation. Please call at least: CL provides the phone numbers for
patient to call for transportation 1-855-222-1218 (TTY 771)