SynerMed

RESOURCES Forms, Manuals, Physician Training & Tools

Authorization Forms
Senior Annual Health Assessment/Encounter Forms
Claims Forms
Manuals
Newsletters
Influenza Resources
Grievance Forms
Clinical Practice Guidelines
Health Education
Culture & Linguistics
Physicians Training & Tools
Member Resources
Health Plan Incentives for Primary Care Providers
Miscellaneous Forms

Click on desired Adobe pdf document to open and download:

Authorization Forms

Senior Annual Health Assessment/Encounter Forms

Claims Forms

Provider Dispute Form

Manuals

The documents listed below can be quite large and take a few minutes to download. Please be patient...

Newsletters

Influenza Resources

Los Angeles County Department Of Public Health Influenza Resources

Grievance Forms

Grievance Form

Clinical Practice Guidelines

We have provided clinical practice guidelines that have been reviewed by the SYNERMED's Quality Improvement Committee. You may find these guidelines helpful in managing care in common areas of everyday medical practice.

Preventive Health Guidelines for 2006

Ages 0-18 Years
- Recommended Childhood and Adolescent Immunization Schedule - United States, October 2006 Advisory Committee on Immunization Practices, Department of Health and Human Services, Centers for Disease Control and Prevention
- AAP Periodicity Schedule
- CHDP Periodicity Schedule for Pediatric and Adolescent Health Assessment
- Recommendations for Preventive Pediatric Health Care (RE9535) - American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, 1999.
- The Guide to Clinical Preventive Services, 2007, Recommendations of the U.S. Preventive Services Task Force - Agency for Healthcare Research and Quality, Rockville, MD.
Ages 19-65 Years
- Recommended Adult Immunization Schedule - United States, October 2005-September 2006, Advisory Committee on Immunization Practices, Department of Health and Human Services, Centers for Disease Control and Prevention
- The Guide to Clinical Preventive Services, 2007, Recommendations of the U.S. Preventive Services Task Force - Agency for Healthcare Research and Quality, Rockville, MD.
Childhood Immunization Schedule 2008
Adult Immunization Schedule 2008

Health Education

	You may request information on how to request interpreter services and how to obtain a poster which is translated into LA County’s 10 threshold languages that will inform patients that they can receive interpretation services at no cost by calling SYNERMED's C & L Department @ (213) 437-4219 X 1467 or by clicking here to see the information and the poster that are available to you.

	STAYING HEALTHY ASSESSMENT TOOL

	• 0-3 Years old
	English \| Spanish \| Lao \| Russian \| Vietnamese \| Chinese \| Hmong

	• 4-8 Years old
	English \| Spanish \| Lao \| Russian \| Vietnamese \| Chinese \| Hmong

	• 9-11 Years old
	English \| Spanish \| Lao \| Russian \| Vietnamese \| Chinese \| Hmong

	• 12-17 Years old
	English \| Spanish \| Lao \| Russian \| Vietnamese \| Chinese \| Hmong

	• 18 Years and older
	English \| Spanish \| Lao \| Russian \| Vietnamese \| Chinese \| Hmong

Alcohol & Drug Abuse
•	Do You Know Someone Who Has a Drinking Problem English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Asthma
•	Controlling Your Asthma English \| Spanish

High Blood Pressure
	You Can Control Your High Blood Pressure English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Dental
•	Baby's Teeth English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Diabetes
•	Prevent Diabetes Problems English \| Spanish You Have Diabetes English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Exercise / Physical Activity
•	Stay Active & Feel Better English \| Spanish
Every Body Is Made to Move
•	English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Growing up Healthy
	• 0-2 Months old	English	Spanish	Vietnamese
	• 3-4 Months old	English	Spanish	Vietnamese
	• 5-6 Months old	English	Spanish	Vietnamese
	• 7-9 Months old	English	Spanish	Vietnamese
	• 10-12 Months old	English	Spanish	Vietnamese
	• 13-15 Months old	English	Spanish	Vietnamese
	• 16-23 Months old	English	Spanish	Vietnamese
	• 2 Years old	English	Spanish	Vietnamese
	• 3 Years old	English	Spanish	Vietnamese
	• 4-5 Years old	English	Spanish	Vietnamese
	• 6-8 Years old	English	Spanish	Vietnamese
	• 9-12 Years old	English	Spanish	Vietnamese
	• 13-16 Years old	English	Spanish	Vietnamese

Family Planning
	Call for details

HIV Prevention
	Call for details

Immunizations
•	After the Shots - What to do if your child has discomfort English \| Spanish
All Kids need Hep B Shots! English \| Spanish

Injury Prevention
	Call for details

Nutrition
•	Be Healthy - Eat Five or More Fruits and Vegetables a Day English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Obesity / Weight Management
•	Embrace Your Health! Lose Weight if you are Overweight English

Parenting
	Call for details

Pregnancy & Breastfeeding
Breastfeeding Resource Directory - 2008

Preventive Health Guidelines & Recommended Immunization Schedule for Adults
•	Preventive Health guidelines& Recommended Immunization Schedule for Adults English \| Spanish

Preventive Health Guidelines & Recommended Immunization Schedule for Children and Adolescents
•	Preventive Health Guidelines & Recommended Immunization Schedule for Children and Adolescents English \| Spanish

Sexually Transmitted Disease (STD's) Prevention
•	STD Prevention English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Staying Healthy Tip Sheets
•	0-3 Years old English \| Spanish \| Armenian \| Chinese \| Farsi \| Hmong \| Korean \| Tagalog \| Russian \| Vietnamese
•	4-8 Years old English \| Spanish \| Armenian \| Chinese \| Farsi \| Hmong \| Korean \| Tagalog \| Russian \| Vietnamese
•	9-11 Years old English \| Spanish \| Armenian \| Chinese \| Farsi \| Hmong \| Korean \| Tagalog \| Russian \| Vietnamese
•	12-17 Years old English \| Spanish \| Armenian \| Chinese \| Farsi \| Hmong \| Korean \| Tagalog \| Russian \| Vietnamese
•	18 Years and older English \| Spanish \| Armenian \| Chinese \| Farsi \| Hmong \| Korean \| Tagalog \| Russian \| Vietnamese

Smoking Prevention and Cessation
•	You Can Stop Smoking English \| Spanish \| Armenian \| Chinese \| Farsi \| Korean \| Khmer \| Russian \| Tagalog \| Vietnamese

Tuberculosis
	Call for details

Upcoming Member Classes
	What To Do When My Child Gets Sick

Culture & Linguistics

Click here to download Referral Request Form.
Interpretation Services Poster

A translated poster informing patients that they can receive interpretation services at no cost must be posted in visible areas in your office (i.e. reception desk, waiting room, exam room, etc.). This poster is translated into LA County’s 10 threshold languages and will inform patients that they can receive interpretation services at no cost. Click here to download a copy of the Free Interpreter Services Poster.
Click here to download Request Refusal Form.
Click here to download Staff Language Capabilities Form.
Click here to download Policy & Procedure QMP 128, "Cultural & Linguistic Services".

Physicians Training & Tools

CMS has changed its payment methodology to Health Plans. As such in order to maximize the revenue to the plan our providers need to code properly. The providers need to pay special attention to CHRONIC ADDITIVE CONDITIONS. Therefore accurate chart documentation and diagnosis reporting now determines reimbursement. In other words accurate encounter data is crucial. Below is a training aid for you and your staff to ensure you are coding correctly.

HCC Training Presentation (MS Power Point)
Listing of HCC Codes and their Weighting (MS Excel)

Member Resources

Health Plan Contact Information for all Client/Medical Groups

Molina Health Plan After Hours authorization line (800) 357 0163
Website: www.molinahealthcare.com
LA Care Health Plan After Hours authorization line (877)-431-2273
LA Care Nurse Advise Line for Healthy Families & Healthy Kids (800) 249-3619
Website: www.lacare.org
Care 1st Health Plan After Hours authorization (800) 468-9935
Website: www.care1st.com

Explanation of Coverage (EOC)

Websites of Health Plans

Miscellaneous

Department of Mental Health (Medi-Cal) – (800) 854-7771
Quality Management Policy & Procedures
IPA Accessibility for Utilization Management Issues
Weight Management Classes - Adult for Care 1st Members (March 2008)
Weight Management Classes - Adult for Care 1st Members (April/May 2008)
Pneumococcal Vaccine - What You Need To Know
English | Spanish
Referral to Specialists and Criteria Used for Utilization Management Decisions

Health Plan Incentives for Primary Care Providers

Miscellaneous Forms

Chemotherapy Treatment Request (CTR) Form