This article is intended for CHW subcontractors only. It outlines the health plans that Pear Suite is currently contracted with, which means your organization can subcontract under Pear Suite to serve members enrolled in these plans and submit claims accordingly.

Currently Contracted Health Plans

Pear Suite maintains active contracts with the following health plans:

• CalViva Health
• Community Health Plan of Imperial Valley
• Santa Clara Family Health Plan
• Mountain Valley Health Plan *
• Central California Alliance for Health
• Health Plan of San Joaquin *
• L.A. Care Health Plan *
• Anthem Blue Cross Blue Shield
• San Francisco Health Plan
• Independent Living Systems (Kaiser) (currently paused due to an ongoing issue)
• Contra Costa Health Plan
• Partnership Health Plan of California *
• Alameda Alliance for Health *
• Health Net
• Kern Family Health Systems *
• Molina Healthcare California
• Gold Coast Health Plan

* Plans marked with an asterisk have additional compliance or onboarding requirements. If your CHWs begin seeing members under any of these plans, contact your Customer Success Manager so we can share the specific requirements with you before you begin.

Plans We Are Not Currently Contracted With

The following are some of the major health plans Pear Suite is not yet contracted with:

• Health Plan of San Mateo
• Community Health Group Partnership Plan
• CenCal Health
• Inland Empire Health Plan
• Blue Shield of California Promise Health Plan
• CalOptima

Applications have been submitted for many of these plans. We'll continue updating our subcontractors as new health plans are added to our network.

A Note on Straight Medi-Cal

Pear Suite is not contracted to bill straight Medi-Cal. Members must be enrolled in a managed care health plan — such as one of the plans listed above — in order to submit claims through Pear Suite. If a member has Medi-Cal but does not have a managed care plan, they are not eligible for billing under your subcontract at this time.

Update: Medicare Subcontracting

Pear Suite now supports subcontracting for direct Medicare billing, which allows you to serve and submit claims for members in the 65+ population. If your organization is interested in subcontracting for straight Medicare, reach out to your Customer Success Manager to begin that process.

Questions?

If you're unsure whether a member's plan is covered under your subcontract, or if you have questions about compliance requirements for any of the asterisked plans, contact your Customer Success Manager before beginning services.