Helpful Tips 999 And 997 Responses
- A response file will be produced and posted to your trading partner mailbox for each file you submit to Xerox EDI Direct. It is imperative that you retrieve your response files to determine whether your files were accepted, errored or rejected. If your response file contains any value other than an “A” in the IK5, AK5 or AK9 and you are unsure of the error or rejection, please contact our EDI Commercial Support Team at the number or email below.
- The most common rejections identified are the subscriber ID and the secondary ID .
- The subscriber ID in loop 2010BA NM109 should be a 9-byte ID .
- Secondary IDs or Legacy IDs should not be present in the provider loops, with the exception of the tax ID in the 2010AA Billing Loop.
Choose A Primary Care Provider
If you haven’t received one already, you’ll get a GCHP welcome packet in the mail soon. It will have instructions you need to follow in order to access care.
One of the first steps we ask you to take is to choose a Primary Care Provider . A PCP is a doctor or a clinic you will see for all of your main healthcare needs, like checkups and sick care visits.
You will not receive a GCHP membership card until you’ve declared a PCP. To select a PCP, you’ll need to:
- Choose a PCP that is part of the GCHP network within 30 days of becoming a member. We will assign one to you if you do not make a selection. View our list of plan-approved providers.
- Select PCPs for any other family members covered by your plan.
- Let GCHP know which doctor or clinic you pick. Please call member services at . If you use a TTY, call . Or send us your completed PCP Selection Form . We will send you a postage-paid envelope for this.
- Schedule a checkup with your PCP within the first 120 days of becoming a GCHP member.
If you’re ever unhappy with the PCP you chose, you can change your selection after one month of being their patient. Learn how to change your PCP.
Reach Our Member Services Department
When you have questions, our Member Services team will help explain your coverage and how to get the services you need.
We can answer your questions in English or in Spanish. If you speak a language other than these, we will be happy to provide the interpreter services you need.
Just give us a call at . If you use a TTY, call . Please call from 8 a.m. to 5 p.m. Monday through Friday, excluding holidays.
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Gold Coast Health Plan
Gold Coast Health Plan proudly serves more than 230,000 Medi-Cal beneficiaries in Ventura County through its network of primary care physicians, specialists, behavioral health providers, hospitals, and pharmacies. Since it was founded in 2011, Gold Coast Health Plan has been committed to providing access to high-quality care and improving the health of its members, which include 1 in 5 county residents, 1 in 8 seniors, and 1 in 2 children up to the age of 5.
Some Members Don’t Need To Choose A Pcp
You do not need to pick a PCP if you’re an administrative member. For example, you may have this type of membership if you:
- Have Medi-Cal with share of cost.
- Live in a long-term care facility.
- Have Medi-Cal provided by Ventura County but live outside the area.
- Have additional insurance on top of your Medi-Cal coverage.
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Advance Health Care Directive Form
You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.
More Guides About The Login At Home
Welcome Providers | Gold Coast Health Plan . Gold Coast Health Plan and its providers are committed to delivering quality care to their members. We maintain a robust provider network that includes more than 4,900 providers, 187 pharmacies and most of the local hospitals and long-term care facilities in Ventura County. Visit site
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Attend A Benefits Information Presentation
New to GCHP? We invite you to attend one of our Benefits Information meetings. Some of the things you will learn about are:
- Medi-Cal benefits and how to use them.
- Your rights as a GCHP member.
- How to choose and change your Primary Care Provider .
- Getting dental, vision and mental health services.
- Scheduling rides to and from your medical appointments.
- Resources you can use to improve your health.
To find out when and where our next Benefits Information meeting is, please visit our calendar.
Your Member Handbook And Id Card
You should receive a copy of the Member Handbook and a GCHP ID card in the mail after you’ve picked a PCP. Please bring your ID card to your doctor visits.
To learn how to use your benefits and access care:
- Please read your member handbook and other materials you will get in the mail carefully.
- Go to a new member benefits presentation in English or Spanish. View our upcoming presentation dates and times.
If you need to see a doctor or visit the emergency room before your ID card arrives, that’s OK. Please show the doctor your welcome letter and Medi-Cal benefits identification card .
You can get services from a Medi-Cal provider who accepts Medi-Cal Fee for Service . Please ask if the doctor accepts FFS when you make your appointment.
If you have a medical emergency before you’ve received your member ID card, call 911 or go to the nearest ER. Show the ER staff your Medi-Cal BIC card.
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Committee Appointment Application Form
A committee appointment application form must be completed and submitted to the Clerk of the Commission for individuals wishing to serve on committees and or boards that provide guidance to the Ventura County Medi-Cal Managed Care Commission, doing business as Gold Coast Health Plan.
GCHP is currently accepting applications to fill vacancies on its Community Advisory Committee.
Read the notice and access the application form.
Which Systems Are Excluded
Enterprise systems do not include cyber security systems, infrastructure and mechanical control systems, or information that would reveal vulnerabilities to, or otherwise increase the potential for an attack on, a public agency’s IT system. Additionally, section 6270.5 does not automatically require disclosure of the specific records that the IT systems collect, store, exchange or analyze. The act’s other provisions pertaining to disclosure of such records still apply.
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Which Enterprise Systems Are Covered By Sb 272
Section 6270.5 of the California Public Records Act requires local agencies to create a catalog of multi-departmental systems or systems containing information about the public that store original records and post it on their agency website with annual updates on July 1.
Section 6270.5 defines an enterprise system as a software application or computer system that collects, stores, exchanges and analyzes information that the agency uses that is a multi-departmental system or system that contains information collected about the public and a system of record. A system of record means a system that serves as an original source of data within an agency.
Gold Coast Provider Portal Login
The Gold Coast Health Plan Provider Portal provides online access to member eligibility information and gives users the ability to enter … Current Status. … password that you chose when you signed up at Gold Coast Provider Portal Login or that was issued to you by the concerned organization’s authorized person. And you shall use only … Visit site
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What Your Health Plan Covers
This chapter explains your covered services as a member of GCHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask GCHP for pre-approval for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call . If you use a TTY/TDD, call or 711.
Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information.
Some of the basic health benefits GCHP offers are listed below. Benefits with a star may need pre-approval.
Does Gold Coast Health Plan Support Electronic Funds Transfer
Gold Coast Health Plan supports electronic funds transfer . Providers who enroll in EFT will have their Medi-Cal payments directly deposited in their checking or savings account. The EFT option is currently available to in-network providers in Ventura County. Download the Electronic Funds Transfer Form.
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Perinatal Substance Use Services
Gold Coast Health Plan works with the Ventura County Perinatal Substance Use Task Force, a multi-hospital and multi-disciplinary group. The goals of the Task Force are to ensure that all pregnant women are screened for the risk of substance use, depression, and domestic violence during pregnancy, and to provide comprehensive, caring support, education, and resources to women identified as being at-risk. Data shows that early intervention leads to improved sobriety, less recidivism, improved mother-baby bonding, and lowers other risk factors for the developing fetus. The California Maternal Quality Care Collaborative has developed a toolkit describing best practices to improve outcomes for substance-exposed mothers and newborns.
The Task Force has an easy-to-follow decision tree for obstetrics providers, which uses best practices of the CMQCC toolkit for the Screening Assessment and Level of Care Determination. This tree includes contact information, including direct links, to numerous resources throughout the county.
Questions about where / how / whom to refer? Contact Ventura County Public Health nursing:
Website: www.vchca.org/perinatal-substance-use-services
Services
If You Have Additional Medical Insurance
Do you have health insurance through your work, parents, spouse or Medicare? If so, Medi-Cal will be your secondary insurance.
That means your primary insurance will be the first to cover the cost of any medical services you receive. Be sure to show all of your health insurance cards when you go to a medical appointment.
Please inform Medi-Cal of any other insurance coverage you have. This will help you avoid problems when you see your doctor or go to get prescriptions filled.
To update your insurance records with Medi-Cal, you can call:
- The Human Services Agency at . If you use a TTY, call 711.
- The Social Security Administration if you have Supplemental Security Income or Medicare benefits. Call them at . If you use a TTY, call .
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What Is The Gold Coast Health Plan Provider Portal
The Gold Coast Health Plan Provider Portal provides online access to member eligibility information and gives users the ability to enter authorization requests, check status of authorizations, and check the status of claims. Office managers request and maintain user privileges for themselves and for office staff.
