Non-Billable Services
Enhanced Care Management (ECM) is a program dedicated to care coordination for members in support of their established ECM care plan. As Medi-Cal members, ECM members also have access to, and should be connected to, the full scope of benefits and services the Plan has to offer. Though ECM is a comprehensive program, services provided and billed under ECM do not include:
- Transporting the member.
- Members should be connected to appropriate transportation services.
- Interpretation services.
- Member should be connected to the Plan sponsored interpretation services.
- Housing navigation and other services covered by Community Supports.
- Members should be connected to a trained and experienced Community Support provider for these services.
- Unsuccessful post-enrollment member telephonic outreach attempts.
- These activities are not successful or meaningful to the member’s care plan goals.
- General check-in calls.
- Direct service delivery – dental care, primary care physicians (PCPs) visits, optometrist visits, therapy sessions, nutrition counseling, etc.
- ECM is responsible for connecting the member to these services, not providing medical or other services.
- Overlapping services – Services covered by other benefits or programs.
- Acting as a member’s caregiver.
- While attending a member’s appointment (when first time navigating a new treatment or medical campus) can be an ECM billable activity, the ECM program is not intended for the Lead Care Manager to go to all member appointments with them as a caregiver, interpreter or transporter.