239 0 obj <>/Filter/FlateDecode/ID[<83360FD95CA05F45B574A1D9EA790D9E><8D3891AAE79CCE46B9E9D8437B49CB46>]/Index[132 165]/Info 131 0 R/Length 199/Prev 202791/Root 133 0 R/Size 297/Type/XRef/W[1 3 1]>>stream WebAnthem Community Resource Link connects you with the help you need. endstream endobj 133 0 obj <. Q: Do CS providers need to conduct a housing quality inspection? WebBehavioral Health: Commercial (Non-Medicaid/Medicare) Form. 1 Children/youth go live in July 2023, unless otherwise stated. WebECM helps coordinate primary care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources. Health education: This may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions. Claims & Billing. This resource page has been developed to provide tools and resources to help providers easily navigate the CalAIM program so they can better serve our members. Referrals DO NOT take the place of prior authorizations. You can find the form under the Forms & Tools section. Our forms are organized by state. After you submit an RTF indicating the member qualified and consented to be enrolled into ECM, you will receive a separate authorization letter for ECM services. We work collaboratively with hospitals, group practices, independent behavioral health care providers, community, government agencies, human service districts and other resources. The ECM encounter can and should be billed directly to the Health Plan for those visits when the provider develops and/or performs work related to the health action plan. Call 800-743-3333 (TTY 711) if you have hearing or speech loss. For information on how to bill for ECM and CS services, please refer to our billing guidance page. Documentation: Its recommended you upload one or more of the following documents with this request: ED or inpatient discharge paperwork Documentation of homelessness by service providers, PCP, specialists, or outreach providers Q: Who can I contact for information regarding an outreach list or an ECM guide? Individuals and families experiencing homelessness, Individuals at risk for avoidable hospital or emergency department utilization, Individuals with serious mental health and/or substance use disorder needs, Adults living in the community and at risk for long-term care institutionalization, Adult nursing facility residents transitioning to the community, Individuals transitioning from incarceration, Children and youth enrolled in California Childrens Services (CCS) with additional needs beyond the CCS condition, Children and youth involved in child welfare, Individuals with intellectual or developmental disabilities (I/DD), Pregnant and postpartum individuals at risk for adverse perinatal outcomes, Nursing facility transition/diversion to assisted living facilities, Community transition services/NF transition to a home, Environmental accessibility adaptations (home modifications), Bridge the gap between physical and behavioral healthcare service delivery, Reduce health disparities and promote health equity, Achieve improvements in quality performance, Community Supports provider capacity building and MCP take-up, Control and prevention of chronic or infectious diseases, Accessing healthcare and understanding the healthcare system, Connecting to community resources, addressing healthcare barriers, or addressing healthrelated social needs (in other words, food and nutrition, housing security, economic support, legal services, etc. A. Any San Francisco resident who is an older adult (60 years or older) or an adult with disabilities (18 59 years old) is invited to join us for breakfast and lunch at community sites located across the city of San Francisco, CA. 6. WebEnhanced Care Management (ECM) and Community Supports (CS) are foundational components of CalAIM. Referral date: Member/caregiver informed of referral? All of the program cards will be categorized by CS services specific to county and ZIP Code. A. ; Find Care Choose from quality doctors and hospitals that are part of your plan with our Find Care tool. Refer to the Guide to Disaster Assistance Services for Immigrant Californians (PDF) for services to help with housing, food, basic needs, health care and counseling, insurance, replacing documents, and employment. Effective as of January 1, 2022, the CalAIM Incentive Payment Program (IPP) is intended to support the implementation and expansion of Enhanced Care Management services and Community Supports by incentivizing managed care plans (MCPs) to: MCPs that elect to participate in the IPP must report on measures in each of these priority areas: Stakeholders interested in applying for IPP funds should visit the This is called prior approval. We will review your PCPs request The platform increases visibility to CS programs for ECMs, providers and community partners, making it easy to use when referring members to CS providers and closing the loop on referrals. There is no rent reasonableness standard or fair market rent requirement for Housing Deposits. ECM Enrollment Start and End Dates are not required for members who declined or who do not qualify for ECM. It covers up to four hours per day for up to 62 days or 248 hours of care in a calendar year. WebTitle. Yes. WebA library of the forms most frequently used by healthcare professionals. A. At Anthem Blue Cross (Anthem), we value you as a provider in our network. You or your caregiver can also call Anthem to find out if and when you can receive ECM. Submit via fax at 877-734-1857. WebAnthem Blue Cross Community Supports Member Referral Form Page 8 of 10 . CalAIM is for members at all levels of risk and need, while also differentiating and specializing in unmet social needs through Enhanced Care Management (ECM) and Community Supports (CS). A. General findhelp website. WebMore support from your community. Managing your health on the go with useful apps, Kentucky Cabinet for Health and Family Services, Commission of Children with Special Health Care Needs, Department for Aging and Independent Living (DAIL), Privacy Guidance When Selecting Third-Party Apps (English), Privacy Guidance When Selecting Third-Party Apps (Spanish). Last Update 05/23/22 A.Bradley . WebAnthem Blue Cross Community SupportsMember Referral Form Page2of2. Please refer to the Housing Deposit Item List Example (PDF) in the Forms & Tools section under Community Support (CS). WebAnthem Blue Cross Community SupportsMember Referral Form Page2of2. Prior Authorizations will need to be obtained through Anthem BC&BS when mandated by 23-315 Community Supports Quick Reference Guide English (PDF). A. LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. When you need a little extra help, it can be hard to know where to go. Answers to your medical questions any time, night or day, 1-855-661-2025 (TTY 711) Personal Home Helper FAQ. A. MIFs are submitted via the sFTP site. Does that amount rollover? Disease Management; Enhanced Personal Health Care Program; Early and Periodic Screening, Diagnostic and Treatment; Rights and Responsibilities Documentation: Its recommended youuploadone or more of the following documents with. A. Web2023 Individual Enrollment Application for California. Recorded billing trainings are available online. A. WebECM Referral Forms to any of the following: Submit completed referrals via the provider website Fax: 877-734-1854 Secure email at CalAimreferrals@anthem.com Contact the Anthem Blue Cross (Anthem) Customer Care Center Monday to Friday, 7 a.m. to 7 p.m. at 800-407-4627 (TTY 711) or 888-285-7801 (TTY 711) for members in Los Angeles Complete and submit a referral form when requesting prior authorization for Community Supports (CS) services. WebHymn Blue Crabby (Anthem) is working with the California Department of Health Care Services (DHCS), precinct and other local partners to implement the California Advancing and Create Medi-Cal (CalAIM) select.CalAIM aims for turn Medi-Cal, making the program more equality, matching, and person-centered to help Anthem community maximize their health The date the member decided not to participate in the program should be populated under ECM Enrollment End Date. Vaccination is important in fighting against infectious diseases. CalAIM Incentive Payment Program Initiatives Webpage or email CalAIM@anthem.com to ask your CalAIM IPP related question. Complete the following form to add or remove ECM user accounts on findhelp. Q: Will the Health Plan be monitoring the number of referrals to each provider to ensure there are no capacity issues or should each provider turn off access to their program once capacity has been met? A. Get help finding food, jobs, housing and other things you may need. A. We look forward to working with you to provide quality services to our members. From there you'll find people and groups in your area who can help with food, work, Recently completed communications can be accessed below. Please contact Provider Services for assistance. Grandfathered members do not require an initial outreach so the one-time outreach does not apply to them. Doulas have been shown to prevent perinatal complications, improve birth outcomes, and reduce health disparities. Precertification requests should be submitted using our preferred electronic method via https://www.availity.com. Learn more about behavioral health resources. 2 Currently available in Los Angeles County. WebReferrals and requests for CBAS can be made by the member, caregiver, family member, or provider A prior authorization is required for all CBAS services. effective 1/1/2023. Achieve improvements in quality performance. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. A. A. No, the link to the findhelp portal is made available on our website and other providers can also access findhelp to start a referral. Our Health Plan opted into specific CS services on January 1, 2022. WebOfficial Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and nonclinical needs of high-cost, high-need, managed care members. PY 1 (January 1, 2022, to December 31, 2022), PY 2 (January 1, 2023, to December 31, 2023). Health WebREFERRAL FORM Referral For (Please Check One) Essex 515 Valley Street, Suite 180 Maplewood, NJ 07040 973-313-0976 973-313-2479 (FAX) Residential Supportive . A. Do not sell or share my personal information. Oakland, CA 94612 When you need a little extra help, it can be hard to know where to go. Email Us, 730 Polk Street Eligible diagnoses (effective 03/15/22) include: Step 1: Client must have an eligible diagnosis. WebREASON FOR REFERRAL By my signature (below), I am attesting that 1) I have performed care coordination activities and collaborated with the Community Stabilization provider as part of my discharge planning 2) the member is in need of Community Stabilization Services as part of a comprehensive discharge plan. Forms; Provider manuals and guides; Training Academy. WebReferral Forms. Or select Click to Call on the Quitline homepage to have a specialist call you. Q: For those who transition into the ECM program, what information do we need to complete for outreach? Indianas parent-to-parent organizationoffering advice and resources to families of children with special needs. requiring special diet Skilled nursing discharge plan CHW services are preventive health services for individuals who need assistance in receiving care to prevent disease, disability, and other health conditions or their progression so to prolong life and promote physical and mental health well-being. If you qualify, you may be contacted about ECM services. Q: Is there a suggested timeframe to accept a referral as a provider offering CS service? Q: Is there training for the ECM data exchange files? only one program (choose either physical health or behavioral health CM based on primary referral reason). Yes. Provider updates sent on the monthly RTF will be included in the MIF. No. How do we get linked to findhelp to track referrals? The goal of this program is to provide medically tailored meals to people living with chronic conditions in order to improve their health and well-being and reduce medical costs. Other Forms. CHW preventive services can be categorized into two groupshealth education and health navigation. If you prefer to paper fax, please utilize the forms listed. Contact CHWP at 877-658-0305 to identify the user with Account Management access in your organization if you do not know who it is or need to assign a user with that access. Precertification requests should be submitted using our preferred electronic method via Q: Do we have an authorization form for CS? 6 Community Supports (CS) are a menu of services, which, at the option of an Managed Care Plan (MCP) and a member, can substitute for covered Anthem Blue Cross is the trade name of Blue Cross of California. You can indicate "signature on file/SOF" on the claim or invoice when submitting. We currently don't offer resources in your area, but you can select an option below to see information for that state. Interested in joining our provider network? A. You can also send inquires to your Health Plan's mailbox at CaHealthWellness_ECM_ILOS@cahealthwellness.com if a liaison has not yet contacted you. Community Nutrition Program. There is currently no specific order. Q: We already signed up through CHWP to provide support services. 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. 1-866-864-2544 (TTY 711) Yes. WebBSC Promise Community Supports Eligibility Criteria and Exclusions Checklists for San Diego (PDF, 199 KB) Providers can also contact the Blue Shield Promise Health Plan Community Supports team: Los Angeles providers: LACommunitySupports@blueshieldca.com. The California state budget allocated $300 million for incentive payments to Medi-Cal managed care plans (MCPs) for state fiscal year (SFY) 2021-2022, $600 million for SFY 2022-2023 and $600 million for SFY 2023-2024. As of January 1, 2022, findhelp is working with CHWP and Aetna to roll out the assessment function. 3180 Newberry Dr., Suite 200 San Jose, CA 95118 View Map (T): 408.513.8700 (F): 408.448.4055 info@healthtrust.org. Call one of our Medi-Cal Customer Care Centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside L.A. County). The recommended method is to submit authorization requests through the provider portal. 132 0 obj <> endobj If you have the member's signature on file, you don't need to provide it on each claim/invoice. CalAIM aims to transform Medi-Cal, making the program more equitable, coordinated, and person-centered to help Anthem members maximize their health and life trajectory. WebThere are some treatments and services your PCP must ask us to approve before we will pay for you to receive them. Q: If a member enrolls and then decides to not participate in the program, what would the code be? Doula services include personal emotional and physical support to women and families from pregnancy experience through childbirth and postpartum. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Get Our Latest Updates. Forms CalAIM findhelp function: As a CS provider, you will be added to the CalAIM function and categorized in specific CS services after you contract with our Health Plan. A. If you are interested in providing service in multiple counties, select all applicable counties on the form (only one form is needed). Just enter your Zip Code. Please refer to the DMAS memo for more Rather, wait for our team member to send you the certification application after you submit the PIF. Each organization can have at least one user with Account Management access to the provider portal that will allow them to control access for other members in the organization. Only CS@scfhp.com. If you need help filling out the form or have any questions, please call 831-430-5512. this request: Success requires the investment and sustained commitment of a broad network of health partners, including plans, providers, and community-based organizations, with WebMember and Family Support Services: Assessing and educating the members social support system to promote self-efficacy, Including peer support and self-care activities. WebSubmit completed referrals via the provider website Fax: 877-734-1854 Secure email at CalAimreferrals@anthem.com Contact the Anthem Blue Cross (Anthem) Customer Care Provider information . If the client is not eligible, Client Services will contact the referring party. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and patients against contagious illnesses. Use our Community Resource Link to find free or low-cost services near you. Community Supports (CS) authorization guides were developed to provide guidance to CS providers based on the Department of Health Care Services (DHCS) eligibility criteria. Validation of completion of these assessments will be done via file review and data monitoring. WebWe would like to show you a description here but the site wont allow us. Q: Are Medi-Cal members able to self-refer? Only Enhanced Care Management (ECM) services do not need prior authorization starting January 1, 2023. WebBehavioral health providers. Personal Care and Homemaker Services Referral Form English (PDF) Respite Services (for Caregivers) Referral Form Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), California Department of Health Care Services (DHCS), Enhanced Care Management Member Referral Form, CalAIM Community Supports Flyer - Spanish, CalAIM Incentive Payment Program Initiatives Webpage, Northern California (Colusa, Glenn, Butte, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Yuba), Gold County (Amador, Calaveras, Inyo, Mariposa, Mono, Tuolumne), https://pcgus.jotform.com/222306493964865, CalAIM Enhanced Care Management claims guide, CalAIM Enhanced Care Management Quick Reference Guide, CalAIM Enhanced Care Management and Community Supports Overview, CalAIM Enhanced Care Management Member Referral Form, CalAIM Community Supports Member Referral Form, CalAIM Enhanced Care Management Program Completion Questionnaire (PCQ), CalAIM Community Supports - Reauthorization Form. Expected to go live statewide in 2024. or fax to . hb``d``b``` Q: Will the Health Plan keep and provide historical data submitted by providers on the monthly RTF? Please attach clinical information to support medical necessity: This referral is valid only for services authorized by this form. Looking for a form but dont see it here? You will need to submit one claim per member. Shop plans for Medicare, Medical, Dental, Vision & Employers. WebCommunity Support. Yes No The CalAIM findhelp website is available to all providers and does not require a log in to access the network of contracted CalAIM CS providers. Call 211. WebPlease email referral form securely to: Submit via email at CalAIMReferrals@anthem.com. Q: Is a member able to request a specific ECM or CS provider they want to be assigned to? The date of enrollment should be populated under ECM Enrollment Start Date. Submit the completed form to the email address on the form. Q: What is the difference between the provider portal, Conduent and findhelp? No, we do not have a required referral or authorization form template for CS. Claims & Billing. %%EOF Q: How can we update the contact information listed for our organization in the provider directory? Please ensure you follow the billing guidance and add modifier GQ when billing for telehealth. Please select your state Our forms are organized by state. Call one of our Medi-Cal Managed Care (Medi-Cal) Customer Care Centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside L.A. County). Q: If we are making phone calls to access services for the member, can these be billed as ECM phone services or can we only bill for phone calls with the member? Submit the completed form to the email address on the form. Complete and submit a referral form when requesting prior authorization for CommunitySupports (CS) services. A. California Health & Wellness Plan (CHWP): 877-658-0305. CS providers are entities with experience and expertise providing one or more of the CS to individuals with complex physical, behavioral, developmental, and social needs. You do not need authorization for ECM, but if the member is currently not assigned to an ECM provider for outreach or service, please complete the ECM referrals form to confirm member's qualification and submit a referral through the fax or through the authorization tab in the provider portal. WebPlease note, this form applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc. A. This can be captured under Telephonic/Electronic and Time Spent. We will be working with our providers to identify additional data that will be helpful for program expansion. The services are provided as a Please We highly encourage providers to use the CS authorization guides to determine if the member qualifies for CS services. Get free poison prevention advice and treatment. Medi-Cal Member Recommendation for Community Health Worker Services English (PDF). Use the Provider Maintenance Form to update your email. A. The MIF is sent no later than the 15th of the month and the RTF is due the 5th of the following month. This work is separate from any clinical care coordination provided to the member. Please complete a form below as it pertains to the service and county(ies) you would like to provide service. Providers can reach out and enroll them in the program if they qualify based on provider assessment. Provider Authorization [590 Program membership information for outside the 590 Program facility] State Form 15899 (R5/10-18)/OMPP 2021. You can learn more about specific programs and agencies, and find contact information you need on the CHFS website. Pharmacy. Provider Reference Contact List. Members do not have to contact Anthem for a referral. Gloucestershire Community-based Support for Stroud, Cheltenham and Cotswolds (online referral portal) Community-based Support for Gloucester, Tewkesbury and Forest of Come and enjoy a time full of fun with giveaways, school supplies, raffles, resources, refreshments, and much more. Or will we need to re-enter details every month? This should be defaulted to 1 minute. authorization, medical information)? Personal Home Helper provides in-home support for caregiver respite, home-based chores and activities of daily living (ADL) to address needs while recovering from injury or illness. A. WebIndianas Medicaid Home and Community-Based Services (HCBS) Waiver program provides individualized supports to assist people, of all ages, to live successfully in home and community settings. The resources for our providers may differ between states. If you have finalized your contract, please contact findhelp directly and they can help you set up. Project Open Hand Wellness Programs are available to residents of San Francisco and Alameda County who are eligible based on a primary diagnosis. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. Version Date. A revised copy of the RTF was shared with providers. WebCommunity Health Worker Referral Form Case Management Referral Form Diabetes Prevention Program: Patient Referral Form Disease Management/Population Health Referral Form Behavioral Health Treatment/Applied Behavioral Analysis/Autism Services Recommendation Form WebCommunity Living Services Residential Application Easterseals. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Providers can refer members to CS by referring them through findhelp or sending the member information to contracted CS providers in our ECM/CS provider directory. Call one of our Medi-Cal Customer Care Centers at 800 Were here to help. Q: Do we need an authorization form for ECM? 0 Housing Deposit reimbursements will be treated the same as other CS reimbursements and will follow all tax reporting requirements. Q: Are patients who are transitioning from the home health program (HHP) or whole person care (WPC) automatically enrolled into the ECM program? Select a State Forms Library Members can log in to view forms that are specific to their plan. Training foster parents to help kids heal from trauma. Web40625 Community Supports_Meals Referral Form . A. In the past, Medicaid only paid for long-term care services in an institutional setting, such as nursing facilities and group homes. Yes. Meals are not provided to respond solely to food insecurity. A. TAT is dependent on the receipt of all clinical information necessary to render a decision. Download the free version of Adobe Reader. CA Employer Application for Group Benefits (126+ lives) (111 KB ) CA Employer Application for Group Benefits (51-250 lives) (60 KB ) Provider Nomination Form - Dental (83 KB) We serve people across their entire health journey and address their full range of needs with an integrated whole-health approach. CA Employer Application for Group Description. If interested in joining Anthems ECM or CS network, please contact us at CalAIM@anthem.com. CalAIMs bold transformation aligns all elements of Medi-Cal into a system that is standardized, simplified, and focused on helping enrollees live healthier lives. The Findhelp How-To Guide is a step-by-step tool to help CS and ECM providers navigate the findhelp platform. . (Note Project Open Handon the application for referral to our services). No. A. A. WebProvider Forms & Guides. In 2023, DHCS is providing the PATH CPI Collaborative Planning and Implementation.
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