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  • Iehp Referral Tracking Log

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Used Straightforward Detailed Detailed Low complexity Comprehensive Comprehensive Moderate complexity Comprehensive Comprehensive High complexity Face-to-Face Encounter 10 minutes 20 minutes 30 minutes 45 minutes 60 minutes Established Patient CPT Code 99211 99212 99213 99214 99215 Extent of Scope of Degree of History Examination Decision Making Minimal Minimal Minimal Problem focused Problem focused Straightforward Expanded problem focused Expanded problem focused Low complexity Detailed Det.

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IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health.

A referral is a written request from one health professional to another health professional or health service, asking them to diagnose or treat you for a particular condition.

Get with the plan! Many California residents who are uninsured, may be eligible to qualify for healthcare coverage through Medi-Cal, Covered California, or for county-based programs. Apply for health coverage through Medi-Cal and choose IEHP, your Inland Empire Health Plan.

UPON ACCEPTANCE OF REFERRAL AND TREATMENT OF THE MEMBER, THE PHYSICIAN/PROVIDER AGREES TO ACCEPT IEHP CONTRACTED RATES. This referral/authorization verifies medical necessity only. Payments for services are dependent upon the Member's eligibility at the time services are rendered.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232