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Provider Resources

California Health & Wellness providers are an essential means of providing care to our members and as a result we want our providers to have a good understanding of the resources available to them. As a California Health & Wellness Plan provider you can rely on us for:

  • Initial and ongoing education through orientations, office visits, training and updates.
  • A dedicated claims team to ensure prompt payment
  • Timely, informative reports to assist with patient outreach
  • Minimal referral requirements and limited prior authorizations
  • A dedicated provider network relations team with resources available in-person or by phone
  • The ability to check member eligibility, authorization and claims status online
  • Our formulary is now available via the Epocrates smartphone app, which helps providers prescribe the preferred medications by proactively showing them formulary alternatives and coverage limitations
  • A robust Quality Incentive Program that provides bonus opportunities for HEDIS performance improvement

Provider Report, Spring 2016

  • Message from the CEO
  • Quality Incentive Program update
  • Re-Credentialing
  • Pharmacy Home Program Announced
  • ImmunityConnect Launches
  • ED Diversion Program
  • Readmission Prevention
  • Telehealth Pilot Program
  • 2015 Provider Satisfaction Survey Results

Provider Report, Winter 2015

  • Message from the CEO
  • Healthcare Without Hassles
  • HEDIS for heart care
  • HEDIS hybrid season
  • HEDIS for Diabetes
  • Tips for quick claims payment
  • ICD-10 update
  • 2015 Quality Incentive Program update
  • Fluvention 2015 Rolls out
  • New Mental Health Severity Guide
  • Rideout Hospital Joins Provider Network

Provider Report, Fall 2015 (PDF)

  • Message from the CEO
  • Provider Relations adds “Provider Partnership” team
  • You can impact HEDIS
  • ICD-10 Update
  • HEDIS measures in summary
  • 2015 Quality Incentive Program
  • Clinical Practice Guidelines
  • Building our Network
  • What’s your availability?
  • Did you know?

Provider Report, Summer 2015 (PDF)

  • The appropriate use of resources
  • How you can support HEDIS scores
  • Provider Satisfaction Survey
  • Make a difference: Cervical cancer among Hispanic women
  • Authorization reminder
  • Behavioral health services for your patients
  • Medical record maintenance
  • Immunization: A shot at better health
  • Prepare New Parents: Immunization Schedule

Provider Report, Spring 2015 (PDF)

  • ICD-10 Update
  • The Intersection of Asthma and Heart Disease
  • How to Refer to Case Management
  • Member Rights and Responsibilities
  • Disease Management Can Help Your Patients
  • Measuring Performance
  • The Unexpected Reach of Depression
  • Encouraging Regular Prenatal Care
  • Caring for adolescents
  • ADHD On the Rise
  • Four Pharmacy Facts
  • Are You Available?

Provider Report, Fall 2014 (PDF)

  • Appointment Availability
  • Are you in our Provider Directory?
  • How We Strive for Quality
  • Let Our Guidelines Be Your Guide
  • How to Promote Women’s Screenings
  • You Can Impact Our HEDIS Scores
  • Resources for Providing Culturally Competent Care
  • Addressing Patients’ Concerns About the Flu Vaccine