22-076m Enhanced Care Management (ECM) Eligibility Reports Help You Best Serve High-Cost, High-Need Members
Date: 01/31/22
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Use the whole-health approach to deliver comprehensive care
Health Net will publish a new eligibility report each month showing providers which members might qualify for Enhanced Care Management (ECM). Providers can access the reports through the Health Net provider portal.
ECM Eligibility Reports include:
- Member’s demographic information.
- ECM population of focus.
- ECM provider name and NPI.
- ECM enrollment status information.
How to qualify for ECM
To qualify for ECM, a patient must belong to one of the 12 populations of focus (below). If a member is potentially eligible, a number 1 will be under their population of focus.
Access the ECM Eligibility Reports
Providers can access the reports through the Health Net provider portal by following the steps below:
- Log in to the provider portal.
- Select Provider Reports under Welcome. A pop-up will notify you to log in to Healthnet.com.
- Select the green button to Go To Healthnet.com.
- Log in with your Healthnet.com email and password.
- Select Eligibility Report Category.
- Select ECM_RPT_BRM_43 report.
Population of Focus | Description |
|---|---|
Adult – experiencing homelessness | Individuals experiencing homelessness or chronic homelessness, or who are at risk of becoming homeless, with complex health and/or behavioral health conditions |
Adult – high utilizer | High utilizers are members with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits |
Adult – SMI or SUD | Individuals who are at risk for institutionalization who have co-occurring chronic health conditions and serious mental illness (SMI, adults) or substance use disorder (SUD) |
Adult – transitioning from incarceration | Individuals transitioning from incarceration who have significant complex physical or behavioral health needs requiring immediate transition of services to the community |
Adult – LTC eligible/at-risk for institutionalization | Individuals at risk for institutionalization who are eligible for long-term care services |
Adult – nursing facility residents transitioning to community | Nursing facility residents who want to transition to the community |
Child/youth – experiencing homelessness | Children or youth experiencing homelessness or chronic homelessness, or who are at risk of becoming homeless, with complex health and/or behavioral health conditions |
Child/youth – high utilizer | Children or youth with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits |
Child/youth – SED or co-occurring chronic health conditions or psychosis | Children or youth at risk for institutionalization who have co-occurring chronic health conditions and serious emotional disturbance (SED) |
Child/youth – CCS or WCM | Children or youth with complex physical, behavioral, or developmental health needs enrolled in California Children’s Services (CCS) or Whole Child Model (WCM) |
Child/youth – child welfare | Children or youth with complex physical, behavioral, or developmental health needs with a history of involvement in child welfare (foster care) |
Child/youth – transitioning from incarceration | Children or youth transitioning from incarceration who have significant complex physical or behavioral health needs requiring immediate transition of services to the community |
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 800-675-6110.