Members - IMS MSO

Our members

Please click below for information regarding the services we provide for members.

Contacting IMS Member Rights and Responsibilities HIPAA and Privacy Interpreter Services Access Transportation Affirmative Statement Obtaining Decision Making Criteria Community Based Services

Contacting IMS

*IMS provides language assistance, free of charge, in the requested language through bilingual staff or an interpreter.

To request copies of IMS policies and procedures:
During Business Hours: Customer Service Department at 323-800-8283
After-hours: UM Department 1-800-285-6164 (toll free)
Policies will be delivered within five (5) business days from request date.

IMS offers Telecommunications Relay Services (TRS):
TRS permits persons with a hearing or speech disabilities to use the telephone system via a text telephone (TTY). Simply dial 711 to be automatically connected to a TRS operator. It’s fast, functional and free. Dialing 711 can initiate a call from any telephone in the United States, without a seven or ten-digit access number.

Video and Internet-based relay services:
711 dialing access does not work for Video Relay Service (VRS), Internet Protocol (IP) Relay or IP Captioned Telephone Service (IPCTS) Relay calls. Hearing persons initiating a VRS or IP Relay call may do so by calling the provider’s 800 number. IPCTS users should call their party directly and a communications assistant will be automatically connected to the call.

To anonymously report compliance/fraud, waste, abuse concerns:
Compliance Anonymous Toll-Free Hotline (available 24 hours a day, 7 days a week): 1-855-222-1025
Compliance Fax: 1-323-832-8141
Online Reporting: www.lighthouse-services.com/imsmso
Compliance Email: Compliance@imsmso.com

Member Rights and Responsibilities

Members and patients have many key rights and important responsibilities. IMS is committed to seeing to your rights respected, and by upholding your responsibilities, you can ensure a satisfying member experience. Members and patients have the right:

To exercise your rights without regard to race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment,
To be treated with respect, and with recognition of your dignity and privacy,
To be provided with information about your IPA, its services, and the healthcare service delivery process,
To get coverage decision or coverage information from your plan before getting services
To choose health care provider within the plan
To know how your doctors are paid
- When you ask your plan how it pays doctors, the plan must tell you.
- Medicare doe not allow a plan to pay doctors in a way that could interfere with you getting care you need.
To be informed of the name, qualifications and titles of the physician that has primary responsibility for coordinating your care, and to be informed of the names, qualifications and specialties of other professionals who may be involved in your care,
To have 24-hour access to your primary care physician (PCP) or covering physician,
To receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, as well as prospects for recovery in terms that are understandable to you,
To get a treatment plan from your doctor
- If you have a complex or serious medical condition, a treatment plan lets you directly see a specialist within the plan as many times as you and your doctor think you need
- Women have the right to go directly to a women’s health care specialist without a referral within the plan for routine and preventive health care services
To be informed of continuing healthcare requirements following office visits, treatments, procedures, and hospitalizations,
To actively participate in decisions regarding your healthcare and treatment plan. To the extent permitted by law, this includes the right to refuse any procedure or treatment (if refused, an explanation will be given by your provider and will address the effect(s) that this will have on your health),
To have access to personal medical records based upon state and federal requirements,
To be informed of non-emergent costs of care and receive an explanation of your financial obligations prior to incurring the expense (including co-payments, deductibles, and co-insurance),
To examine and receive an explanation of bills generated for services delivered to you,
To be informed of applicable rules in the various healthcare settings regarding member conduct,
To express opinions or concerns regarding your IPA or the care provided; to offer recommendations for change in the healthcare delivery process by contacting your IPA Customer/Member Services Department; to have a timely and organized system for resolving member complaints and formal grievances,
To request an appeal to resolve differences with your plan
To file a complaint (called a “grievance”) about other concerns or problems with your plan,
To be informed of the member grievance and appeals process,
To change your PCP by contacting your health plan,
To receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service, and
To be able to formulate advanced directives for healthcare.

These member rights shall apply to any person that has legal responsibility to make healthcare decisions for you. Members also have the right to be represented by parents, guardians, family members or other conservators if they are unable to fully participate in their own treatment decisions.

HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law requiring the creation of national standards in order to safeguard protected health information (PHI) from being used or disclosed without the member’s knowledge or consent. The HIPAA Privacy, Security, and Breach Notification Rules protect the privacy and security of PHI and provide individuals with certain rights to their health information:

The Privacy Rule – sets national standards for when PHI may be used and disclosed.
The Security Rule – specifies safeguards to protect the confidentiality, integrity, and availability of electronic PHI.
The Breach Notification Rule – requires notifications affected individuals, and in some cases, the media, of a breach of unsecured PHI.

If you have any questions regarding HIPAA, how it impacts you, and your rights please contact us for more information.

Notice of Privacy Practices

Notice of Privacy Practices (eff. 10.1.2020)

This notice is effective October 1, 2020. Please note that Innovative Management Systems (“IMS”) never markets or sells personal information.

Your Information. Your Rights. Our Responsibilities.

This 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.

Your Rights

You have the right to:

Get a copy of your paper or electronic medical record
Correct your paper or electronic medical record
Request confidential communication
Ask us to limit the information we share
Get a list of those with whom we’ve shared your information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

Tell family and friends about your condition
Provide disaster relief
Include you in a hospital directory
Provide mental health care
Market our services and sell your information
Raise funds

Our Uses and Disclosures

We may use and share your information as we:

Treat you
Run our organization
Bill for your services
Help with public health and safety issues
Do research
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions

Member Rights

When administering your health care benefits, we collect various types of protected health information (“PHI”) from you and other sources, including other health care providers. This information may be used, for example, to decide wither we will pay for your care and to see if you are getting the right care; for utilization review; to detect fraud and abuse; to review the qualifications of health care professionals, and to fulfill legal and regulatory requirements. When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
IMS will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we will provide you a written explanation within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You have the right to ask IMS to limit what we use or share. You must tell IMS what information you do not want shared and who you don’t want us to share your information with. We will review and consider your request. IMS is not required to agree with your request if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times IMS shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 3 years.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically, by calling IMS at 1-800-285-6164 or TTY (711). You can also access this notice on our website at www.IMSMSO.com

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights have been violated

You can file a complaint if you feel we have violated your rights by contacting:
- IMS’ Privacy Officer:
  - Email: Compliance@imsmso.com
  - Phone Hotline: 1-844-359-3410
    - This hotline is available 24 hours a day, 7 days a week.
    - Reports can be made
  - Fax: 1-323-832-8141
- IMS’ Customer Service Department
  - Telephone: (323) 505-4457
  - Toll-free: (877) 830-6880
  - TDD/TTY: (866) 461-4288
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please let us know.

You have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the following cases, we never share your information unless you give us written permission:

Marketing purposes
Sale of your information
Most sharing of psychotherapy notes

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways:

To treat you
- We can use your health information and share it with other professionals who are treating you.
- Example: A doctor treating you for an injury asks another doctor about your overall health condition.
To run our organization
- We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Example: We use health information about you to manage your treatment and services.
To bill for your services
- We can use and share your health information to bill and get payment from health plans or other entities.
- Example: We give information about you to your health insurance plan so the health plan will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information, please see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when a individual passes.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice and the changes will apply to all information we have about you. The revised notice will be available upon request, in our office, and on our website.

Interpreter Services

Brand New Day Health Plan

English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-255-4795 (TTY: 711).

Spanish: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-255-4795 (TTY: 711).

Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-866-255-4795（TTY：711）

Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-866-255-4795 (TTY: 711).

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-866-255-4795 (TTY: 711).

French: ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-866-255-4795 (ATS : 711).

German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-866-255-4795 (TTY: 711).

Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-866-255-4795 (TTY: 711) 번으로 전화해 주십시오.

Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-866-255-4795 (телетайп: (TTY: 711).

Arabic:
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 14795-255-866-1 (رقم هاتف الصم والبكم: (TTY: 711).

Italian: ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-866-255-4795 (TTY: 711).

Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-866-255-4795 (TTY: 711).

Haitian Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-255-4795 (TTY: 711).

Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-866-255-4795 (TTY: 711).

Hindi: ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-866-255-4795 (TTY: 711) पर कॉल करें।

Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-866-255-4795 (TTY: 711) まで、お電話にてご連絡ください。

Armenian: ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-866-255-4795 (TTY (հեռատիպ)՝ 711):

Farsi: 1-866-255-4795 توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما تماس بگیرید.- (TTY: 711) فراهم می باشد. با.

Punjabi: ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-866-255-4795 (TTY: 711) ‘ਤੇ ਕਾਲ ਕਰੋ।

Cambodian: ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ 1-866-255-4795 (TTY: 711) ។

Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-866-255-4795 (TTY: 711).

Thai: เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร। -866-255-4795 (TTY: 711).

Imperial Health Plan

English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-838-8271 (TTY: 711).Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-838-8271 (TTY: 711).

Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-708-5976 (TTY: 711).

Transportation

Brand New Day Members

CareCar Transportation Benefit

It’s simple, reliable, and safe!

Schedule your ride a day in advance and call 1-855-804-3340, TTY 711 – available 24 hours a day, 7 days a week. You can also schedule your ride online at www.carecar.co/schedule. Before you schedule, have your Brand New Day Member ID and trip details like pick up and drop off addresses. CareCar will create a profile for you based on any medical conditions or special needs – we take care of the rest!

CleverCare Members

It’s simple, reliable, and safe!

Schedule your ride a day in advance and call 1-855-804-3340, TTY 711 – available 24 hours a day, 7 days a week. You can also schedule your ride online at www.carecar.co/schedule. Before you schedule, have your IN Physicians/Clevercare Member ID and trip details like pick up and drop off addresses. CareCar will create a profile for you based on any medical conditions or special needs.

For more questions, please refer to your plan Summary of Benefits or call IN Physicians Member Services at 323.800.8283, TTY 711. Hours of Operation are 8AM to 8PM, seven days a week.

Imperial Health Plan Members

Please call 1-800-838-8271 (TTY: 711) and select Extension 4 to set up a transportation appointment with an Imperial Health Plan member services representative.

Astiva Health Plan Members

How to schedule a ride with CareCar:

Calling

1.844.743.7179, TTY: 711
24 hours a day, 7 days a week
24 hours Advanced Scheduling is recommended.

Online

carecar.co/schedule

For more information, please refer to your plan Summary of Benefits or call Astiva Member Services 1.866.688.9021, TTY 711. Hours of Operation are 8AM to 8PM, seven days a week.

Affirmative Statement

IMS employees who are in a position to review, conduct, or make medical decisions are not influenced by financial incentives, bonuses, or additional compensation relating to the quality of, access to, or utilization of health care services rendered to members. Physician reviewers are not rewarded for issuing denials of coverage. All decisions are reviewed using evidence-based criteria and guidelines, and/or based on the member’s Health Plan’s Evidence of Coverage benefits.

To discuss denials, obtain an appeal, or discuss medical review criteria, please contact our Customer Service Team at 323-800-8283.

Obtaining Decision Making Criteria

Clinical criteria related to a utilization decision is made available to Members, Providers, and the public, and may be requested by contacting the Utilization Management Department. Requests may also be submitted via fax, portal, or by phone request at 323-800-8283. The criteria will be delivered within one (1) business day of the request.

Community Based Services

Coming soon