All new Alliance members must receive an Initial Health Appointment (IHA). The IHA consists of a history, physical and mental health exam, identification of risk, age-appropriate preventive screens or services, health education, and diagnosis and plan for treatment of any disease. For Medi-Cal members, this must be completed within 120 days of plan enrollment or provider assignment. Alliance network PCP compliance will be assessed during site audits. The effective date of enrollment is defined as the first of the month following the notification from the DHCS that the member is an eligible Alliance member. For infants born to Alliance members, the effective date of enrollment is the infant’s date of birth.

The IHA should consist of an evaluation sufficient to enable Alliance network PCPs to assess the acute, chronic, and preventive health needs of the member and assume responsibility for effective management of the member’s health care service needs.

For children, the IHA must consist of the elements found in the most recent periodicity schedule recommended by Bright Futures/American Academy of Pediatrics (AAP). PCPs must provide preventive health visits for all members through 21 years of age at times specified by the most recent AAP periodicity schedule. The IHA must bring members up to date with all currently recommended preventive services and include all assessment components required by AAP. Alliance network PCP compliance will be assessed during site reviews and on-going chart audits.

To ensure that members are seen for an IHA, providers are to outreach to members and document at least two (2) attempts to schedule/reschedule an appointment in the medical record. 

CPT and Z Codes that qualify for IHA

* For a member previously enrolled with the Alliance.