Transition of Care

Continuity of Care for Existing Relationships

We recognize the importance of nurturing the patient-PCP relationship to establish care continuity for members. Some members may already have existing relationships with a provider prior to their enrollment with California Health & Wellness. California Health & Wellness supports continuation of previous or existing relationships between providers and members through its ongoing member outreach efforts. These outreach efforts start when we first receive notification of the member’s enrollment with our plan and when we learn of an existing member-PCP relationship (such as through State claim data, member initiated contact, provider rosters or similar means). If the pre-existing relationship is with a provider who is a contracted PCP, we link the member and provider in our eligibility system and generate an ID card that contains the assignment of the member to the PCP.

If a member has been receiving services from a provider who is not contracted with California Health & Wellness and the member wishes to continue receiving services from the provider, the member can complete and submit a California Health & Wellness, which can be accessed by using this link: CoC Request Form. California Health & Wellness may approve the request; the approved duration may vary based upon the medical condition and eligibility of the member, but will not exceed 12 months. At a minimum, the following criteria must be satisfied for a Continuity of Care Request to be considered:

• The member established a relationship with the provider that is not contracted with California Health & Wellness prior to the effective date of the member’s enrollment in the plan;
• The provider meets applicable professional standards and does not have a record of any disqualifying quality of care issues; and
• The provider is willing to continue treating the member and accepts California Health & Wellness' reimbursement rates.

If you would like to choose a different PCP or need more information, please contact Member or Provider Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) or consult California Health & Wellness' Member Handbook.

We know change can be scary. California Health & Wellness wants to make this change easy. Whether you are new to managed care or are changing health plans, we will be sure to help you through the transition. Call our Member Services department toll-free at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) if you have questions about transitioning your care.