Kern Family Health Care (“KFHC”) is a Medi-Cal Managed Care Plan. KFHC is required to provide all non-contracting hospitals in the State of California with contact information needed to request authorization for post stabilization care when a KFHC Member receives emergency medical care from a non-contracting hospital as set forth in the Health and Safety Code, Section 1262.8(j).
KFHC requires non-contracted hospitals to obtain prior authorization prior to providing post stabilization care to KFHC enrolled Members. KFHC requests the treating Physician and Surgeon’s diagnosis and any other relevant information reasonably necessary to make a decision in authorizing post stabilization care or to assume management of the patient’s care by prompt transfer.
- The non-contracted hospital shall make contact with KFHC by either following the instructions on the patient’s health care service plan member card or;
- Call the Utilization Management Department’s phone number to obtain timely authorization for post stabilization care:
Monday through Friday / Hours: 8 a.m. to 5 p.m., Pacific Standard Time (PST)
Afterhours: 800.391.2000 and ask for the Administrator on call or;
- Send a face sheet with the member’s demographic information to the Utilization Management Fax number: 661.664.5190.
When KFHC is contacted by a non-contracted hospital pursuant to Section 1262.8 shall, within 30 minutes of the time the hospital makes the initial telephone call requesting information, either authorize post-stabilization care or inform the hospital that it will arrange for the prompt transfer of the enrollee to another hospital.
When KFHC is contacted by a non-contracted hospital pursuant to Section 1262.8, KFHC shall reimburse the hospital for post-stabilization care rendered to the enrollee if any of the following occur:
- KFHC authorizes the hospital to provide post-stabilization care.
- KFHC does not respond to the hospital’s initial contact or does not make a decision regarding whether to authorize post-stabilization care or to promptly transfer the enrollee within the timeframe noted above.
- There is an unreasonable delay in the transfer of the enrollee, and the noncontracting Physician and Surgeon determines that the enrollee requires post-stabilization care.
KFHC shall not require a non-contracted hospital representative or a non-contracting Physician and Surgeon to make more than one telephone call pursuant to Section 1317.4a (c)(2) to the number provided in advance by KFHC. The representative of the hospital that makes the telephone call may be, but is not required to be, a Physician and/or Surgeon.
An enrollee who is billed by a hospital in violation of Section 1262.8 may report receipt of the bill to the health care service plan and the Department. The Department shall forward that report to the State Department of Public Health.
For purposes of this notification, “post-stabilization care” means medically necessary care provided after an emergency medical condition has been stabilized.
Completed facility claims for authorized Health Care Services must be sent to:
Kern Family Health Care
PO Box 85000
Bakersfield, CA 93380
For any additional questions or to contact us regarding post-stabilization care, please contact us at the number below:
KFHC Member and Provider Services: 800.391.2000