Apply for PCH

Overview

The Apply for PCH feature allows attorneys and case managers to enroll patients in the Pacific Crest Healthcare Independent Provider Association (IPA). This enrollment process establishes a single consolidated lien for all in-network medical services, streamlining billing and payment processes while ensuring coordinated care.

Key Benefits

• Single Consolidated Lien: Replace multiple individual provider liens with one master lien
• Network Access: Connect patients with PCH's extensive network of healthcare providers
• Expense Management: Better track medical expenses against available insurance coverage
• Simplified Billing: Streamline the medical billing process for all parties involved
• Coordinated Care: Ensure patients receive consistent, quality care across providers

Form Sections

The Apply for PCH form consists of several sections that collect all necessary information to process a patient's enrollment. Below is a detailed guide to completing each section.

Patient Demographics

This section captures essential contact and identifying information for the patient. All fields marked with an asterisk (*) are required.

Figure: Patient Demographics form with fields for law firm information, patient details, and address information

Law Firm Information

Field	Description	Required
Firm	Select your law firm from the dropdown menu. If your firm is not listed, please contact PCH support.	Yes
Attorney	Select the responsible attorney for this case.	Yes
Case Manager	Select the case manager assigned to this patient.	Yes

Patient Personal Information

Field	Description	Required
First Name	Patient's legal first name as it appears on identification documents.	Yes*
Last Name	Patient's legal last name as it appears on identification documents.	Yes*
Date of Birth	Patient's date of birth in MM/DD/YYYY format.	Yes*
Phone Number	Patient's primary contact phone number.	Yes*
Email Address	Patient's email address for digital communications and notifications.	Yes*
Accident Type	Select the type of accident/injury from the dropdown menu.	Yes*

Home Address

Patient's primary residential address information:

Field	Description	Required
Street	Street address including house/apartment number.	Yes*
City	City name.	Yes*
State	State (select from dropdown).	Yes*
Postal Code	5-digit ZIP code.	Yes*

Work Address

Patient's employment address information (if applicable):

Field	Description	Required
Street	Street address of employment location.	No
City	City name.	No
State	State (select from dropdown).	No
Postal Code	5-digit ZIP code.	No

Tips for Completing Patient Demographics

• Ensure all contact information is current and accurate to prevent delays in processing
• If the patient has recently moved, use their most current address
• For patients without email addresses, consider using the law firm's email with the patient's name in it
• Double-check all required fields before proceeding to the next section

Legal Case

Accident Information

This section captures details about the accident or incident that led to the legal case. Accurate information here is critical for determining coverage eligibility and lien management.

Figure: Accident Information form with fields for case details and accident description

Field	Description	Required
Case Type	Select the appropriate legal case classification (e.g., Personal Injury).	Yes*
Policy Limit	Enter the insurance policy limits in the format "XX / XX" (e.g., "15 / 30" for $15,000/$30,000).	No
Date of Loss	The date when the accident/incident occurred in MM/DD/YYYY format.	Yes*
State Accident Occurred	The state where the accident/incident took place.	Yes*
Statute Of Limitation	The deadline date for filing legal action in MM/DD/YYYY format.	No
Accident Description	Detailed narrative of how the accident occurred, injuries sustained, and other relevant information. Use the rich text editor to format the description as needed.	Yes

Tips for Completing Accident Information

• Be as specific as possible with the accident description, including any relevant details about how the injury occurred
• Include information about the severity of injuries and any immediate medical attention received
• Note any police reports or incident reports that were filed
• If the policy limit is unknown, just select 30/60 which is the lowest limit available.

Recommended Procedure

This section allows you to specify any medical procedures that have already been recommended for the patient. Providing this information helps the PCH team begin the underwriting process immediately.

Figure: Recommended Procedure section for specifying pre-recommended medical treatments

Field	Description	Required
Procedure Type	Select the type of medical procedure that has been recommended for the patient.	No

Tips for Completing Recommended Procedure

• If a healthcare provider has already recommended a specific procedure, selecting it here will expedite the approval process
• Include only procedures that have been formally recommended by a qualified healthcare provider
• If multiple procedures have been recommended, select the most urgent or significant one
• If no procedures have been recommended yet, you can leave this section blank

Prior Treatment

This section documents any medical treatment the patient has received prior to applying for PCH membership. Tracking these external medical bills is important for accurate underwriting and case management.

Figure: Prior Treatment section for documenting previous medical care and procedures

Treatment Categories

Category	Description	Fields
Ambulance	Emergency transportation services	Ambulance Company
ER	Emergency room visits	Emergency Room (facility name)
Imaging	Diagnostic imaging services	-
MRI	Magnetic Resonance Imaging scans	Count (number of MRIs)
CT	Computed Tomography scans	Count (number of CT scans)
XRay	X-ray imaging	Count (number of X-rays)
Ultrasound	Ultrasound imaging	Count (number of ultrasounds)
Chiro / PT	Chiropractic care or Physical Therapy	Number of Visits
Pain Management / Injections	Pain management treatments	-

Procedures Performed

This subsection allows you to document specific medical procedures the patient has already undergone:

Field	Description
Procedure	Select the specific procedure from the dropdown menu
Count	Number of times this procedure was performed

Use the + Add button to include multiple procedures as needed.

Surgeries Performed

This subsection allows you to document surgical procedures the patient has already undergone:

Field	Description
Surgery	Select the specific surgery from the dropdown menu
Count	Number of times this surgery was performed

Use the + Add button to include multiple surgeries as needed.

Tips for Completing Prior Treatment

• Check all applicable treatment categories the patient has received
• Be as accurate as possible with counts and visit numbers
• Include all relevant procedures and surgeries, even minor ones
• If you're unsure about exact counts, provide your best estimate
• This information helps PCH track external medical bills and account for them during underwriting
• Complete documentation here ensures better coordination of care and more accurate case valuation

Injuries

This section allows you to document known injuries before receiving official medical reports. Providing preliminary injury information helps PCH begin assessing the case and planning appropriate care pathways.

Figure: Injuries section for documenting known patient injuries

Field	Description	Required
Name	Custom name or description of the injury	No
Body Part	Anatomical location of the injury	No
Injuries	Type of injury (Laceration, Burn, Soft Tissue, Fracture, TBI)	No
Severity	Level of injury severity	No

Use the + Add button to document multiple injuries as needed. The red trash icon allows you to remove an injury entry if needed.

Tips for Completing Injuries Section

• Document all known injuries, even if you don't have complete medical confirmation yet
• Be as specific as possible with the body part (e.g., "Left Wrist" rather than just "Arm")
• Select all applicable injury types for each body part
• If severity is unknown, you can leave that field blank
• This preliminary information helps PCH prepare for the case before receiving full medical documentation
• This information will get updated automatically when the medical records are added to the platform.

Insurance

This section allows you to inform PCH about insurance policies associated with the case. Accurate insurance information is essential for proper lien management and coordination of benefits.

Figure: Insurance section for documenting associated policies

Third Party Insurance

Information about the defendant's or other parties' insurance:

Field	Description	Required
Insurance Type	Select "Defendant/Third Party/Other Parties Insurance"	No
Insurance Company	Name of the third-party insurance carrier	No
Coverage Amount	Policy limit (e.g., "15/30" for $15,000/$30,000)	No
Coverage Status	Select from: Liability Accepted, Disputed, Unknown	No

First Party Insurance

Information about the client's/plaintiff's own insurance:

Field	Description	Required
Insurance Type	Select "Client/Plaintiff/First Party"	No
Insurance Company	Name of the first-party insurance carrier	No
Coverage Amount	Total coverage amount	No
MediCal	Dollar amount of MediCal coverage (currency field)	No
PIP	Dollar amount of Personal Injury Protection coverage (currency field)	No
UM/UIM	Dollar amount of Uninsured/Underinsured Motorist coverage (currency field)	No

Use the + Add button to document multiple insurance policies as needed. The red trash icon allows you to remove an insurance entry if needed.

Tips for Completing Insurance Section

• Include all known insurance policies that may be relevant to the case
• Be as accurate as possible with coverage amounts and policy limits
• If coverage status is unknown, select "Unknown" rather than leaving it blank
• For first party insurance, include all applicable coverage types (MediCal, PIP, UM/UIM)