Postpartium Program Flow Chart
Pregnancy Notification Form
Please fill out and fax the PREGNANCY NOTIFICATION FORM to Care1st Health Plan within 30 days of the identification of the pregnancy.
The fax number is 323-889-6578. By faxing this information to us we will be able to provide important educational materials to your
patient and be able to assist you with any needs you may have. Please encourage your patient to keep all of her prenatal appointments.
It is very important to make sure the patient is seen for a complete OB exam within the first trimester or within 42 days of enrollment
with the health plan.
CPSP Referral Form
This form is to be filled out by the patient in your office. A copy of this form must be kept in the patient file.
The patient needs to decide if she wants CPSP services by checking the appropriate box and signing the CPSP REFERRAL FORM.
A copy of this form is to be faxed to Care 1st along with the PREGNANCY NOTIFICATION FORM to (323) 889-6578.
If you are not a CPSP certified physician and your patient requests CPSP services, please select a certified physician from the
CPSP Provider Directory link below.
CPSP
Provider Directory
This is a link directly to the CPSP WEBSITE AND PROVIDER DIRECTORY. If you would like to find out
which CPSP providers are contracted with Care1st, please contact Lisa Zavala at 323-889-6638 extension 6471.
CPSP Instructions
We have included CPSP INSTRUCTIONS to assist you in completing the CPSP Prenatal and Postpartum tools. Included are the most
common CPSP codes utilized for reimbursement.
CPSP Prenatal Assessment Tool
The CPSP PRENATAL ASSESSMENT TOOL is a very comprehensive ten-page assessment of your patient. You can have the member
fill in as much information as possible and have a staff member help, if needed. The entire assessment tool must be completed for a
full risk assessment. The Healthy Start Program Staff is available by phone at (323) 889-6638 to assist your patient.
Individualized Care Plan (ICP)
Develop an ICP for your CPSP patient for specific concerns identified on the CPSP Prenatal Assessment Form.
You can contact our Healthly Start Program Staff at (323) 889-6638 to assist you with the development of an ICP.
CPSP Postpartum Assessment Tool
CPSP POSTPARTUM ASSESSMENT TOOL is a brief two-page tool that must be completed between 21st and 56th day following delivery.
You can contact our Healthly Start Program Staff at (323) 889-6638 to assist you with the CPSP Postpartum Assessment Tool.
Prenatal and Postpartum Care Guidelines
The PRENATAL AND POSTPARTUM GUIDELINES are based on the American College of Obstetricians and Gynecologist Prenatal and Postpartum Care Guidelines.
They are enclosed for your convenience.
Delivery Form
The DELIVERY FORM needs to be filled out by you after your patient delivers. Your patient is eligible for a $50 Gift Card
if she was seen during the 1st trimester for her initial OB examination or within 42 days of enrollment and has kept all of her
prenatal visits during her pregnancy. Please fax the completed "Delivery Form" along with prenatal medical records to 323-889-6578.
The Healthly Start Program Staff will notify your patient if she qualifies for the $50 Gift Card.
Postpartum Visit Form
The POSTPARTUM VISIT FORM needs to be filled out by you after your patient completes her postpartum visit. This visit must be completed
between 21st and 56th day after delivery for your patient to be eligible for the $10 Gift Card
and for you to be eligible for the $50 Incentive payment. Please fax the completed Postpartum Visit Form along with
postpartum medical records to 323-889-6578. The Healthly Start Program Staff will notify your patient if she qualifies. Also mail the
completed HFCA 1500 and necessary claim forms to our Claims Department for processing of your $50 Incentive.
Early Discharge Member Advisement Form
According to Title 22 Health & Safety Code Section 1367.62, a pregnant member has the right to remain in the hospital for 48
hours following a vaginal delivery or 96 hours following a Caesarian Section. The member needs to be informed of the availability of
a post discharge visit within 48 hours of discharge from a hospital and this visit may be in the home, in the physicians office, or
at a plan facility. Care1st will fax a Member Advisement Form to the treating OB physician’s office and the hospital,
upon notification of an OB delivery. Once the OB provider completes the Member Advisement Form, it is to be faxed to Care1st Health Plan at
(323) 889-6579.
