Initial Health Assessment (IHA)

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. During site audits, a PCP’s compliance with this standard will be assessed and is part of the yearly performance incentive.

The IHA should consist of an evaluation sufficient to enable the PCP 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 the DHCS website, please click here to access.

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 shall 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 does 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 lower age nearest to the current age of the child.

Codes that qualify for IHA (new member):

Provider

CPT Code

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

OB/Gyn

59400, 59510, 59610, 59618

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

 

Nursing Home

99304-99306

New or Established Patient Comprehensive Nursing Facility Assessments

 

 

Codes that qualify for IHA (previously with the Alliance):

Provider

CPT Code

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

OB/Gyn

59400, 59510, 59610, 59618

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

 

Nursing Home

99304-99306

New or Established Patient Comprehensive Nursing Facility Assessments

 

PCP

99211 – 99215

 

Office or other outpatient visit for the evaluation and management of established patient