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Exhibit M

COMMUNITY HEALTH PLAN

Subject:

NETWORK UPDATES

Objective:

To establish guidelines for maintaining accurate and current Community Health Plan Medi-Cal Managed Care Program, County Temporary Employee, Healthy Families Program, Personal Assistance Services Council (PASC)-Service Employees International Union (SEIU) Homecare Workers Health Care Plan (HWHCP), and other developing or established product lines’ Provider and Primary Care Site information.

Director Approval:

Division Chief Approval:

Effective Date: 08-20-03

Revision Date: 08-20-03

Supersedes:

08-07-02

Reference:

POLICY:

The Community Health Plan (CHP) Los Angeles County Department of Health Services (DHS) Facility Liaisons and Individual Practice Association (IPA)/Medical Group Contract Liaisons (DHS Facility/Contract Liaisons) shall inform Provider Relations of changes affecting Provider and/or Primary Care Site (PCS) information no less than sixty (60) days prior to the effective date of the change. For purposes of this policy, the term Provider includes primary care physicians, specialty providers, and mid-level providers (Nurse Practitioner, Physician Assistant, and Nurse Mid-Wife). Changes to be communicated to CHP include, but are not limited to, addition or deletion of providers; change in Child Health and Disability Prevention Program (CHDP) or Comprehensive Perinatal Services Program (CPSP) status; and change of provider s address, telephone number, business or personal name, office hours, etc.

PURPOSE:

  • 1)

    To ensure that the CHP Provider databases reflect the Providers correct demographic information.

  • 2)

    To ensure L.A. Care Health Plan (L.A. Care) is notified of CHP Medi-Cal Managed Care Network changes on a monthly basis and in turn forwards the current Medi-Cal information to the State contractor [Health Care Options (HCO)].

  • 3)

    To ensure L.A. Care is notified of HWHCP Network changes on a monthly basis and in turn updates the HWHCP provider database and Web site.

  • 4)

    To ensure the Managed Risk Medical Insurance Board (MRMIB) is notified of CHP Healthy Families Program Network changes on a quarterly basis.

  • 5)

    To ensure that the CHP Provider Directories contain accurate and current Provider information.

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