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, preventive 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. Alliance network PCP compliance will be assessed during site audits.

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.

Codes that qualify for IHA

Provider
CPT Codes
Z Codes
Description
Behavioral Health 96156 Health behavior assessment, or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making)
OB/Gyn 59400, 59425, 59426, 59430, 59510, 59610, 59618 Z1000, Z1008, Z1020, Z1032, Z1034, Z1036, Z1038 Under vaginal delivery, antepartum and postpartum care procedures, under cesarean delivery procedures, under delivery procedures after previous cesarean delivery, under delivery procedures after previous cesarean delivery
PCP 99202-99205, 99461 Z1016 Office or other outpatient visit for the evaluation and management of new patient
PCP 99211-99215 Z00.01, Z00.110, Z00.111, Z00.8, Z02.1, Z02.3, Z02.5 Office or other outpatient visit for the evaluation and management of an established patient with PCP but new to the Alliance
PCP 99381-99387 Comprehensive preventive visit and management of a new patient
PCP 99391-99397 Comprehensive preventive visit and management of an established patient with PCP but new to the Alliance

* For a member previously enrolled with the Alliance.