25-187 Updated CS and ECM Provider Reference Guides

Date: 02/14/25

View the guides at CalAIM Resources for Providers

To meet Medi-Cal contract requirements, Health Net, on behalf of CalViva Health, has conducted a comprehensive review of the CS Reference Guide (PDF) and Enhanced Care Management (ECM) Provider Guide (PDF).

Key revisions

Based on this comprehensive review, relevant sections of these guides have been revised to align with Department of Health Care Services, administrative and Plan updates and changes. The sections with changes are noted below:

Community Supports:

• Section 2: Provider Certification Application
• Section 5: Community Supports Authorization Guides
• Section 8: Member Authorization Request
• Section 12: Provision of CS Data Exchange
• Section 13: Capacity Reporting

Enhanced Care Management:

• Section 1: Introduction
• Section 3: Getting Ready for ECM: The ECM Provider and Care Team
  • 3.1: Provider Experience and Qualifications
  • 3.2: Provider Certification
  • 3.5: Staffing, Provider Capacity and Training
• Section 4: ECM Member Eligibility, Assignment and Enrollment
  • 4.6.1: Confirm Member Eligibility
  • 4.6.5: Member Ability to Change Provider
  • 4.12: Data to Support ECM

Additional information

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.