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IPA/Medical Groups

For more information about the IPAs/Medical Groups SCPMCS serves, please review the following profiles.

  North County Health Services



North County Health Services (NCHS) Is a not- for- profit organization, organized in 1973 to provide health care to residents of north San Diego County. NCHS is a Federally Qualified Health Center (FQHC) with five primary care medical offices located in Carlsbad, Encinitas, Oceanside, Ramona and San Marcos. NCHS has been a client of SCPMCS for its full professional risk contracts with Community Health Group since January 1998. For more information, please visit www.nchs-health.org.

Contracted Health Plans Available

Please click on the name of the plan for more information about each plan.

Welcome Letter


Dear Member,

It's our pleasure to welcome you to North County Health Services. We are dedicated to providing you with quality care and good service to meet your health care needs. As an independent local network of physicians serving our community, we offer personalized care in convenient locations designed to help you and your family stay healthy.

North County Health Services puts patients first and serving your good health is our top priority. When you select a Primary Care Physician from our network, you are choosing your own personal physician to help maintain your good health and treat any medical conditions that may arise. Your Primary Care Physician will see that you obtain necessary services within our large network of providers.

Our Client Services Department is available to answer any questions you may have at (858) 824-7000 during normal business hours. One of our representatives will be happy to assist you.

We look forward to serving your health care needs.

Sincerely,


NORTH COUNTY HEALTH SERVICES



Putting the Patient First

Quality patient care is the first priority of North County Health Services. You can request information about our Quality Management Program. As physicians, we make care decisions based on our patients' needs. As members of your local community, we are dedicated to treating our neighbors with respect and improving the health of our community.


Referrals to Specialists

Your Primary Care Physician can refer you directly to many participating specialists for an initial consultation. This means that you do not have to wait for an authorization if your doctor believes that you need to see a specialist. We deliver quality care in a timely manner with a minimum of paperwork - and no delays. Your local doctor is focused on making sure that you receive the health care services you need.


Wellness Programs

North County Health Services works with participating major health plans to provide you with the information and services you need to stay healthy. In addition to your health plan, many of our physicians offer wellness programs and fitness resources in their offices.

Medical Management

North County Health Services 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 decision-making is based only on the appropriateness of care and service and existence of coverage.

  • North County Health Services does not reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service care.

  • North County Health Services' financial incentives for Medical Management decision-makers do not encourage decisions that result in underutilization.

  • Practitioners are ensured independence and impartiality in making referral decisions that will not influence: hiring, compensation, termination, promotion or any other similar matters.

North County Health Services allows open practitioner-patient communication regarding appropriate treatment alternatives and does not penalize the practitioners for discussing medically necessary or appropriate care for the patient.

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) 824-7000. Messages can be left after hours for the Medical Management staff in their confidential voicemail box for a response the next business day.

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 Practices

Please click on www.nchs-health.org for information about North County Health Services privacy practices.


HIPAA Authorization Form

Your 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.