Initial Health Assessment Tip Sheet
New members that receive a comprehensive IHA within 120 days of enrollment with the Alliance. The IHA must include an age appropriate Staying Health Assessment (SHA) form.
The linked Primary Care Provider (PCP) will be paid on an annual basis, following the end of quarter 4. For additional information refer to the 2021 CBI Technical Specifications. Data will be collected via claims.
When billing for IHAs, PCPs should ensure to use appropriate CPT codes; see full IHA code list on the table at the end of the tip sheet.
The Alliance has implemented the IHA Dummy Code combination to allow providers to report when they’ve attempted to schedule a member at least three times for their IHA appointment. Members will be compliant for an IHA if the provider has documented the following and submitted a claim or uploaded to the Data Submission Tool on the Alliance Provider Portal:
- 3 unsuccessful scheduling attempts
- 2 telephone attempts
- 1 written attempt
- Documentation of attempts must be maintained in the patient’s medical records
The following coding combination is required:
Procedure code: 99499
ICD-10 Code: Z00.00
Note: The Alliance performs random audits to ensure the IHA Dummy Codes were submitted appropriately.
- Run a report from your Electronic Health Record system
- Manually compile patient data
This measure allows providers to submit IHA dummy codes combinations from their EMR/EHR system or paper records to CCAH at the end of the measurement year by uploading data files to the provider portal. The files are required to be submitted as a CSV file to be accepted by Data Submission Tool on the Provider Portal.
All IHA visits require a:
- Comprehensive health history
- Physical exam
- Mental status exam
- Health education/anticipatory guidance
- Behavioral assessment
- Diagnoses and a plan of care.
In addition, the California Department of Health Care Services (DHCS) requires the PCP to administer a SHA form within 120 days of enrollment, and again at defined intervals. For more background information refer to the DHCS Staying Healthy Assessment Website.
Note: For new members enrolled during the public health emergency (PHE), the Department of Health Care Services (DHCS) is temporary suspending the IHA timeframe. DHCS will require the completion of the IHA for those members once the PHE is over. See APL 20-004 for more information.
- Contacting Newly Linked Members
- Pull the list of newly linked Alliance members on a monthly basis. Your 120-day linkage list can be found on the Provider Portal:
- Go to “Linked Member List” and click on “New Members/120 Day IHA” tab
- Review the list and remove patients who have already completed their IHA visit.
- Assign a person (e.g., office manager or call center manager) to ensure new members are contacted.
- Attempt to contact members at least three times. Document that you have made at least 3 unsuccessful attempts (two phone calls and one mailing or vice versa).
- Explain to your patients why this visit is important and reassure them that the cost of the visit is covered by the Alliance.
- Prepare for IHA Visits
- If using an electronic health records (EHR):
- Create a template for IHAs; required elements include:
- Comprehensive history;
- Physical and mental status exam;
- Individual health education;
- Behavioral assessment;
- Plan of care; and
- Staying Healthy Assessment
- If using paper charts, create new patient paperwork packets specifically for IHAs. Be sure to include the age appropriate SHA form! SHA forms can be found at https://thealliance.health/for-providers/manage-care/quality-of-care/health-assessments/
- If using an alternative form:
- Contact the Alliance at least one month before implementation of an alternate SHA. The Alliance will need to verify, and can give permission to use the new SHA, and submit the completed form to DHCS for their final approval.
- Alliance Quality Improvement (QI) nurses can review your IHA template and assist in ensuring it meets State standards. QI nurses can be reached at (831) 430-2622 for assistance.
- IHAs require an extended visit. Establish a routine for scheduling IHAs when the most support staff is available or limiting the number of IHAs scheduled per hour.
- Suggestions for helping IHA visits go smoothly:
- Call patients in advance and fill out their initial health history and SHA form over the phone or via your patient portal.
- Assign two Medical Assistants per provider for IHA visits.
- Brainstorm with your teams to come up with ideas on how they can assist with IHAs.
- Create a template for IHAs; required elements include:
- Ensure Accurate Billing
- Have a billing team member review your IHA billing practices.
- Ensure that you are using the correct CPT and ICD 10 codes to reflect the components of the visit. (See full IHA code list)
- Use IHAs as a tool to improve your Alliance Care-Based Incentives (CBI) All billing codes that qualify for IHAs also give you credit for the following CBI Measures:
- Well Child Visits (3-5 years)
- Adolescent Visits (12-21 years)
- IHAs visits are an opportune time to complete preventative health screenings:
- Cervical cancer screening
- Diabetic health screenings: Retinal Exam, Hba1c good control, Nephropathy screening
- Depression screening
- Talk to your patients about what to do when they get sick and your clinic’s scheduling availability (e.g. same-day appointments, after hours availability, etc.).
- Provide patients with resources for after hour medical advice, including the Alliance Nurse Advice Line. Route after hours calls for Alliance members to the Alliance’s Nurse Advice Line: 1 (844) 971-8907
|Member Population||CPT Billing Codes||ICD-10 Reporting Codes|
|Preventive Visit, New Patient||99381-99387||No Restriction|
|Preventive Visit, Established Patient||99391-99397||No Restriction|
|Office Visit, New Patient||99204-99205||No Restriction|
|Office Visit, Established Patient||99215||CPT and appropriate Diagnosis code: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z01.411, Z01.419, Z00.9, Z02.1, Z02.3, Z02.89|
|Initial Hospital Care||99222-99223 with office visit (99202-99215) within 30-days of discharge||No Restriction|
|Prenatal Care||Z1032, Z1034, Z1038, Z6500||Pregnancy Related Diagnosis|