Providers

Welcome Providers

We Think the Same Way You Do

Care1st is led by physicians with active practices in Southern California.

Here, you'll find a level of understanding and communication that helps both your practice and your patients. And since we're directed by doctors, we have a "patients first" philosophy of care.

Welcome to the Care1st Network

The Care1st network comprises over 7,000 physicians, 80 hospitals and many ancillary medical professionals. Our Provider Network Operations (PNO) department develops and manages the Care1st provider network throughout our service areas. With our information systems, Internet accessibility and experienced management support, we strive to achieve optimal provider satisfaction.

PNO understands the importance of developing and maintaining solid relationships with providers as well as the barriers that the under-served population face in accessing health care services. As a mixed-model HMO, Care1st contracts with individual physicians and Medical Groups/IPAs on a capitated basis. Under the Medical Group/IPA arrangements, many operational functions are delegated with Care1st providing oversight.

Working closely with you.

Our mixed model also offers an opportunity for independent physicians and other provider types to contract directly with Care1st under flexible reimbursement methodologies. It is our desire to be responsive and to work closely with our providers to better understand the challenges facing them. Our objective is to help providers improve the delivery of health care services.


Provider Notifications/Updates (NCQA)


Care1st Special Programs

Medicare

Medi-Cal


Clinical Practice Guidelines Links


Behavioral Health Clinical Practice Guidelines Links


Nursing Facilities Reference Guide

  • Nursing Facilities Reference Guide
    Verifying member eligibility, Determining responsible party for authorization and payment, Submitting Prior Authorization Requests to Care1st, Initial Long Term Care Prior Authorization, TAR data, Authorization Processes, Payment Disputes, Claims, Case Management, Transportation, Continuity of Care, Important Information for Care1st Health Plan and more...

Services:


Access to Care Standards

Care1st uses guidelines to ensure that its members have access to care:


Quality Improvement Annual Summary Reports:


Quality Improvement Program Descriptions

Providing an effective, system-wide, measurable plan for monitoring, evaluating and improving the quality of care and services:


Medical Record Documentation Standards

Care1st’s goal is to assure each patient has a legible, detailed, well organized, confidentially stored, and easily retrievable medical record. These records need to be consistent with standard medical and professional practice and meet the standards of oversight organizations, including Care1st Health Plan and regulatory agencies. Care1st Health Plan recommends a six section format


Affirmative Statement and Utilization Management Criteria

  • Affirmative Statement
  • Utilization Management and Clinical Practice Guidelines