Harbor:NERF

  • New Empanelment Referral Form (NERF) for DHS eligible patients needing PCP
  • How to NERF
  • Prioritize for patients actually need PCP, not for routine PCP follow up
  • Before NERF’ing, ensure that the patient wants a PCP within DHS and has given their preferred phone number.
  • DO NOT NERF patient with 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.
  • Time frame to empanelment depends 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
  • 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.
  • Care Clinic (CCC) is a good resource with adult patient getting discharged with chronic medical condition that cannot get NERF'd quickly (HPE and FFS).
  • Insurance Codes