As of April 1, 2023, AmericasHealth Plan (AHP) is no longer contracted as a health plan with Gold Coast Health Plan (GCHP). All AHP Medi-Cal members are GCHP members.
The AHP transition webpage for affected members can be viewed here.
If you have any questions, please call GCHP Customer Service at 1.888.301.1228 or email ProviderRelations@goldchp.org.
Below are answers to some frequently asked questions (FAQs) that you may have about this transition.
Download the entire FAQs list here.
AHP Member Transition Frequently Asked Questions (FAQs)
Q: Why is Gold Coast Health Plan’s (GCHP) plan-to-plan pilot program with AmericasHealth Plan (AHP) ending?
A: Our partner, Clinicas del Camino Real (CDCR), recently notified GCHP that it would be winding down operations of its wholly owned subsidiary, AHP. As such, GCHP is ending the pilot program with AHP on March 31, 2023.
Q: When is the last day for GCHP’s pilot program with AHP?
A: The last day for the pilot program is March 31, 2023.
Q: What will happen to the members that were delegated to AHP?
A: The more than 9,000 members will be transitioned to GCHP for administration of their benefits on April 1, 2023.
Q: Who should I call if I have any questions after the termination date?
A: If you have any questions, please call GCHP Customer Service at 1.888.301.1228 or email ProviderRelations@goldchp.org.
Q: What will happen to my approved authorization requests?
A: All approved authorizations will be honored by GCHP. There is no need to submit the authorizations to GCHP, as all necessary documentation has been received.
Q: Who should I call if I need to modify an authorization?
A: If there is a modification required for a previously authorized service, no further action is required for dates of service through July 1, 2023. For any dates of service after July 2, 2023, please reach out to GCHP Utilization Management via GCHP Customer Service at 1.888.301.1228.
Q: Will my approved authorizations be honored by CDCR or GCHP?
A: All approved authorizations will be honored by GCHP for dates of service after April 1, 2023.
Q: Do I need to resubmit any outstanding authorization requests to CDCR or GCHP?
A: No, all pending authorizations will be approved.
Q: When is the last day to submit authorizations to AHP?
A: The last day to submit authorizations to AHP is March 31, 2023.
Q: What will happen to my pending claims that have already been submitted to AHP?
A: Pending claims will be paid based on the Med-Cal fee schedule.
Q: Do I submit future claims to CDCR or GCHP?
A: Future claims should be submitted to GCHP for payment. Please submit claims to:
Gold Coast Health Plan
Attn: Claims
P.O. Box 9152
Oxnard, CA 93031-9152
Q: What is the deadline for timely filing of claims?
A: The deadline for timely filing follows Medi-Cal timely filing requirements. A reduction in payment takes effect beginning 180 days after the original date of service.
Q: When is the last day to submit claims to AHP?
A: The last day to submit claims to AHP is March 31, 2023. Starting April 1, 2023, claims should be submitted to GCHP. Claims can be submitted for up to 365 days from the date of service with the Medi-Cal timely filing requirements. A reduction in payment takes effect beginning 180 days after the original date of service.
Q: What will happen to future Medicare crossover claims?
A: Medicare crossover claims will be processed in the same manner as all other claims.
Q: When is the last day that Medicare crossover claims will be accepted?
A: Claims can be submitted for up to 365 days from the date of service under Medi-Cal timely filing requirements. A reduction in payment takes effect beginning 180 days after the original date of service.
Q: When checking member eligibility in the portal for a member that was assigned to AHP, will there be an AHP term date?
A: In the portal, members will still show assignment to AHP until July 1, 2023.
Q: Where will my member be assigned after March 31, 2023?
A: GCHP members can choose to receive their primary health care from any Primary Care Providers (PCPs) in our provider network. Members can follow the existing PCP selection process.
Q: Will members be able to choose their PCP?
A: Yes, GCHP members can choose to receive their primary health care from any PCPs in our provider network.
Q: Will the AHP termination affect members that are currently assigned to CDCR as their PCP, under GCHP?
A: The AHP termination should not affect members that are currently assigned to CDCR as their PCP with GCHP as the administrator of their benefits.
Q: Where should I submit my provider disputes, grievances, and appeals for AHP after March 31, 2023?
A: Please submit your provider disputes, grievances, and appeals for AHP to GCHP.
Q: Will this affect my member that is currently in care management?
A: The member care plan will be transitioned to GCHP for care management.
Q: Will my member’s treatment plan (e.g., scheduled appointment / surgery) be affected?
A: All treatment plans, including scheduled appointments, surgeries, etc., will not be affected. Services should be provided as planned.
Q: Where will the member’s medical records be stored after March 31, 2023?
A: Member medical records are retained by their health care provider.
Q: Who should I call if I have questions regarding a member’s dental, optical, behavioral health, or pharmacy benefits?
A: If you have any questions regarding a member’s benefits, please contact GCHP Customer Service at 1.888.301.1228.
Q: Will this affect my member’s VTS transportation authorization?
A: All approved authorizations will be honored by GCHP. There is no need to submit the authorizations to GCHP, as all necessary documentation has been received.
Q: If my member’s VTS authorization expires after March 31, 2023, who will be extending requests, if needed?
A: GCHP will be responsible for any authorization extensions after March 31, 2023.
Q: Who is responsible for check tracers after March 31, 2023, for missing AHP payments?
A: GCHP will take responsibility for check tracers after March 31, 2023.
Q: Are there exceptions for timely filing for providers that are unaware of the AHP termination, or that are out of area or non-contracted?
A: All claims will be re-directed to GCHP, as well as Provider Dispute Resolutions (PDRs), and any other provider-related communications. Timely filing requirements remain aligned with DHCS standards.
Q: Where should I send recoupment payments after March 31, 2023?
A: Please follow the instructions on the letter requesting recoupment.
Q: Who should I call if I need a copy of an Explanation of Payment (EOP)?
A: Please contact GCHP Customer Service at 1.888.301.1228.