Harbor:NERF

• New Empanelment Referral Form (NERF) time frame varies depending on where the patient is in obtaining Medi-Cal. Where they are in the process will determine how quickly the patient can be NERF’d
• Before NERF’ing, ensure that the patient wants a PCP within DHS and has given their preferred phone number.
• A NERF is not needed for a patient who already has MHLA or has non-DHS Medi-Cal managed care.
  • If the patient no longer wants to get their care from their current MHLA or Medi-Cal managed care provider and the patient confirms that they would prefer to come to DHS, then a NERF may be submitted.
  • Use the Comment Box to indicate that the patient would like to switch their care to a DHS provider. This will help the Patient Relations Team know that the NERF was not submitted in error.
• Patient Relations Rm 1-B-1, x64400 during business hours is great resource for patients to get PCP and navigate insurance (Out of Plan or Out of County, wants to switch to DHS)
• Medi-Cal continuum is complex, check the ‘Additional Patient Info’ on ED Summary or Demographics to find out what patient’s insurance plan is
  • Hospital presumptive eligibility (HPE) 402
    • need to go to Financial Services in 3S to complete their application for Medi-Cal,
    • must do so before the end of the following month.
    • Only good ONCE in 12 months.
  • Fee For Service (FFS) 405 window
    • when application getting processed.
    • Will get packet for them to PICK plan, or will get auto-assigned.
    • Might start out DHS but then turned into OOP later.
  • Restricted 406 for patients
    • don't qualify for a plan due to residency challenges, or self pay
    • CAN GET NERF'd quickly
• Ask Registration if you have any questions on shift
• Patient Access Center/Appointment Center x66500 for patients that want to schedule clinic follow up or enquire about their NERF status.
• Continuity Care Clinic (CCC) [insert link] is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
• Insurance Codes