Member Resources

Referrals & Pre-Approvals

The doctor who refers you will work with you to choose a specialist and let you know if you need pre-approval (prior authorization) or whether you can make the appointment directly.

Referral If you need a specialist for your care, your PCP or another specialist will give you a referral to one. A specialist is a provider who focuses on one type of health care service. Download the Referral and Service Request Form (English)

Pre-approval (prior authorization) For some services, your PCP or specialist will need to ask Community Health Plan of Imperial Valley for permission before you get the care. Download the Referral and Service Request Form (English)

Community Health Plan of Imperial Valley makes sure the care is medically necessary. This is called asking for pre-approval or prior authorization.

Your PCP or specialist will work with Community Health Plan of Imperial Valley to get the pre-approval (prior authorization).

Getting a pre-approval may take 5 days or up to an additional 14 days if we need more information from your PCP. If urgent, it will take no more than 72 hours.

Please refer to your Member Handbook for more information and a complete list of services that require a referral or prior authorization.

The information can be found under Section 3 – How to get Care: Referrals and Section 3 – Pre-Approval (prior authorization).

You can download the Member Handbook (English) or Member Handbook (Spanish).

Member ID Card

Your CHPIV Member ID Card has the name of your health plan, your member ID number, and your Primary Care Provider (PCP) with his/her number. Use your Member ID Card when you visit your doctor, pharmacy and other health care providers.

Provider Network

When you join CHPIV, you can choose your PCP . You can change your PCP at any time. Your PCP will refer you to specialists when needed, such as cardiologists and surgeons.

Download Complete Pharmacy & Provider Directory (English)
Download Complete Pharmacy & Provider Directory (Spanish)
Download Complete Pharmacy & Provider Directory (Supplemental) (Spanish)
Download the Provider Directory Zipped JSON

Pharmacy Services

Your Medi-Cal prescriptions will be covered through Medi-Cal Rx instead of Community Health Plan of Imperial Valley. If you have questions about this or want to find a pharmacy near you, call the Medi-Cal Rx Call Center Line at 800-977-2273. Or, visit www.Medi-CalRx.dhcs.ca.gov.

Part D Program

In most situations, prescriptions are covered only when filled at one of our contracted network pharmacies. These pharmacies partner with Community Advantage Plus to supply covered prescription drugs. A number of retail pharmacies in our network also allow you to pick up an extended supply of your medications. To locate a participating pharmacy, contact Member Services or consult our pharmacy directory.

Community Advantage Plus maintains agreements with more than 40 pharmacies—meeting or exceeding Medicare’s requirements for pharmacy access in the plan’s approved service area.

Extra Help

Extra Help/Low-Income Subsidy (LIS) (English)

This document is still under review. A version in Spanish will be added soon. In the meantime, language assistance services are provided by our team 24/7, free of charge. Call 1-888-484-1412 (TTY: 1-888-671-3263), 24 hours a day, 7 days a week. The call is free.