Initial Health Appointment Guidelines (Medi-Cal)

Initial Health Appointment

Completing a timely Initial Health Appointment (IHA) provides an opportunity for members to establish a relationship with their primary care physician (PCP). In addition, the appointment allows members to obtain necessary health care and preventive services, which can lead to positive health outcomes and improvement in their overall health status.

All newly enrolled Blue Shield Promise Medi-Cal plan members must receive an IHA within 120 days of enrollment, as required in accordance with the Department of Health Care Services’ (APL 22-030). Reasonable attempts must be made to schedule the IHA. If a member refuses to schedule an IHA or does not attend a scheduled appointment, the refusal or non-attendance must be documented by the PCP in the member’s medical record.

The IHA includes, but is not limited to:

• Comprehensive health history (medical, social, family)
• Physical exam, including a systems review
• Immunizations
• Medical testing and treatment
• Health screening for common diseases
• Referrals for follow-up care

As of January 1, 2023, the completion of an Individual Health Education Behavioral Assessment (IHEBA), also known as an SHA (Staying Healthy Assessment form), is no longer required as part of the IHA visit.

All criteria listed in the IHA visit are no longer required to be completed at the initial appointment.

Required provider documentation of the IHA

Although there is no specific form to use, your practice is required to document provision of the IHA, or a comparable comprehensive assessment, in the patient's medical chart. You may use age-appropriate physical evaluation templates (PDF, 133 KB) to complete the documentation. Handwritten documentation must be signed, dated, and legible. Legibility means the record entry is readable by a person other than the writer.

Member outreach

In our efforts to coordinate with and support our Medi-Cal network providers, Blue Shield Promise conducts outreach to all new Medi-Cal members to ensure timely access to completing an IHA. Within 120 days of enrollment, members receive phone calls and new member welcome packet notifying them of this service and encouraging them to call their PCP to schedule their IHA. 

PCP offices are required to contact new members by email, letter, and/or telephone to assess the current need for an IHA and to schedule an IHA for the member within 120 days of enrollment. 

We encourage provider groups/providers to download their new member rosters from Provider Connection. Information on how to download lists can be found at https://www.blueshieldca.com/en/provider/news-education/training. 

Provider compliance

Blue Shield Promise conducts random medical record reviews on a quarterly basis to assess the quality and completion of the IHA visit. After the medical record review, results and findings are provided to the PCP along with resources and guidelines to assist the provider in meeting IHA requirements.  We encourage you to review our IHA Audit Tool for more information regarding IHA requirements.

If you have any questions about providing services or submitting claims for these members, you may also contact Blue Shield Promise Provider Services via Live Chat after logging in at blueshieldca.com/provider or by telephone at (800) 468-9935, 6 a.m. to 6:30 p.m. PT, Monday through Friday.

Resources applicable to the IHA

• All Plan Letter 22-030 (DHCS APL 22-030)
• AAP/Bright Futures Periodicity Schedule
• Advisory Committee on Immunization Practices ACIP Guidelines
• USPSTF Recommendations