For more information about the IPAs/Medical Groups SCPMCS serves, please review the following profiles.
Arch Health Partners
Arch Health Partners (ARCH) is a multi-specialty medical group of over 50 health care providers serving the patients of inland North County since 1992. ARCH contracts with over 300 physicians to provide health care services to managed care patients. For more information, please visit the Arch Health Partners web site at: www.archhealth.org.
Contracted Health Plans AvailablePlease click on the name of the plan for more information about each plan.
Medical ManagementArch Health Partners facilitates the delivery of appropriate care and monitors the impact of its Medical Management program to detect and correct potential under- and overutilization.
Medical Management (MM) staff is available to members and practitioners to receive phone calls or electronic communication (fax). The staff is available during normal business hours five days per week for calls about specific MM cases. The Client Services staff is also available to answer general MM inquiries. You can reach us by calling
(858) 824-7177. After hour calls regarding MM issues will be routed to the staff's confidential voice mailbox.
Members will be provided specific reasons for any denials including a reference to the benefit provision, guideline, protocol or similar criteria on which the denial was based. Members can request a copy of the actual benefit, provision, guideline or criteria on which the decision was based. Members can also request the names of the experts whose advice was obtained in connection with an adverse determination. The member's denial letter notification contains a description of the appeal rights including timeframes for resolution of standard and expedited appeal requests. Members should contact their health plan for assistance in initiating an appeal.
The provision of health services is not influenced by the member's race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Services are provided in a culturally competent and non-discriminatory manner to all members, including those with limited English proficiency or reading skills, the sensory impaired and those with diverse cultural or ethnic backgrounds.
Notice of Privacy PracticesTHIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Arch Health Partners ("ARCH") is required by law to maintain the privacy of protected health information, to provide you with notice of its legal duties and privacy practices with respect to protected health information, and to abide by the terms of the privacy notice currently in effect. ARCH is committed to safeguarding all personal health information and to protecting the privacy rights of our members in accordance with state and federal laws. We consider this information private and confidential and have policies and procedures in place to protect the information against unlawful use and disclosure. We will adhere to these policies and procedures using reasonable and sound business practices.
When necessary for a member's care or treatment, the operation of ARCH's business, the operation of our independent provider organizations, or other related activities; we use protected health information internally, share it with our affiliates, and disclose it to health care providers involved in providing your treatment (e.g., doctors, dentists, pharmacies, hospitals and other caregivers), other insurers, third party administrators, payors (e.g., health care provider organizations, and others who may be financially responsible for payment for the services or benefits you receive under your plan), vendors, consultants, government authorities, and their respective agents. These parties are also required to keep private health information confidential as provided by applicable law or pursuant to a written agreement with ARCH. Some examples of information that we collect and the reasons it might be disclosed to third parties:
To authorize us to disclose any of your personal health information to a person or organization or for reasons other than those described above, please call our Client Services Department at (858) 824-7177 to ask for a special authorization form. When you receive the form, fill it out and send it to us at the following address:
If you fill out an authorization form and later change your mind about the authorization, send a letter to us at the same address, letting us know that you would like to revoke the special authorization. Please provide your name, address, member identification number and telephone number where we can reach you in case we need to contact you about your request. ARCH shall not be liable for disclosures of protected health information made pursuant to a written authorization and prior to ARCH's receipt of your notice of revocation.
You have the right to request restrictions on ARCH's use and disclosure of your protected health information; however, ARCH is not required to agree to your requested restrictions and may instead choose to cease providing services on your behalf.
You have the right to inspect and copy your protected health information, at your expense, unless applicable law contains an exception to your right of access to such information.
You have the right to amend your protected health information maintained by ARCH, unless applicable law contains an exception to your right to amend such information.
You have the right to request and receive an accounting of ARCH's disclosure of protected health information to third parties in the six years prior to the request, except such disclosures of protected health information as are permitted by law to be made without an accounting, unless applicable law contains an exception to your right to an accounting.
You have a right to obtain a paper copy of this notice from ARCH upon request.
If you have any questions about this notice or require additional information about ARCH's privacy practices, or if you believe this policy has been violated with respect to information about you or your dependents, please call our Client Services Department at (858) 824-7177. You also may contact and file a complaint with the Secretary of Health and Human Services pursuant to the procedures set forth in 45 C.F.R. §160.306. You will not be retaliated against for filing the complaint.
ARCH reserves the right to change the terms of this notice at any time in its sole discretion, and to make the new notice provisions effective for all protected health information it receives and/or maintains after the effective date. You will receive notice of any material revisions to ARCH's notice of privacy practices in writing prior to the effective date of such amendment and will be informed how to obtain a revised copy of the notice. The most recent version of our notice of privacy practices also can be accessed at this site.
HIPAA Authorization FormYour IPA/Medical Group needs your approval to share medical information about you with individuals outside of your providers and health plan. You may notify us to release information to anyone (i.e., spouse, child). To authorize the release of this information, please click here to download the HIPAA Authorization Form. You can print and complete the form to return to your medical group.