All new Alliance members must receive an Individual Health Assessment (IHA). The IHA consists of a history, review of systems, physical exam, preventive services and the Individual Health Education Behavioral Assessment (IHEBA). For Medi-Cal members, this must be completed within 120 days of enrollment. Alliance network PCP compliance will be assessed during site audits. The IHA completion rate is also a part of the annual Pay-for-Performance (P4P) program incentive.

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.

The required IHEBA forms can be found on the California Department of Health Care Services (DHCS) website.

For children, the IHA must consist of the elements found in the most recent periodicity schedule recommended by the American Academy of Pediatrics (AAP). PCPs must provide preventive health visits for all members under 21 years of age at times specified by the most recent AAP periodicity schedule. The schedule requires more frequent visits than the periodicity schedule of the Child Health and Disability Prevention (CHDP) program. The IHA must bring members up to date with all currently recommended preventive services and include all assessment components required by the CHDP for the younger age nearest to the child’s current age.

Codes that qualify for IHA

Provider
CPT Code and Description
PCP 99201 – 99205 – Office or other outpatient visit for the evaluation and management of new patient.
PCP 99381 – 99385 – Comprehensive preventive visit (and management of a new patient).
PCP* 99211 – 99215 – Office or other outpatient visit for the evaluation and management of established patient
OB/Gyn 59400 – Under Vaginal Delivery, Antepartum and Postpartum Care Procedures
59510 – Antepartum and postpartum care
59610 and 59618 – Under Delivery Procedures After Previous Cesarean Delivery
Nursing Home 99304 – 99306 – New or established patient comprehensive nursing facility assessments.

* For a member previously enrolled with the Alliance.