26-145 Updated CS and ECM Provider Reference Guides Now Available

Date: 02/05/26

Revisions reflect latest Medi-Cal and Plan requirements

To ensure continued compliance with Medi-Cal contract requirements, Health Net* completed a comprehensive review of the Community Supports (CS) and Enhanced Care Management (ECM) provider reference guides. As a result, several sections have been updated to align with the latest California Department of Health Care Services requirements and administrative guidance.

Access the updated guides

The most up-to-date versions of the CS and ECM provider reference guides are available at CalAIM Resources for Providers.

Summary of updates

Refer to the list below for specific sections in the guide that have been revised.

CS guide updates:

• Section 1: Introduction
• Section 8.1: Confirm Member Eligibility
• Section 8.2.2: Authorization Review Process
• Section 8.3.2: Fax
• Section 9.1.1: Claims
• Section 9.3: Conduent
• Section 9.4: Payment to Providers
• Section 10.2: Health Education

ECM guide updates:

• Section 1: Introduction
• Section 3.2: Provider Certification
• Section 3.3: Medi-Cal Enrollment/Vetting for ECM Providers
• Section 3.5.1: ECM Provider Care Team Staffing
• Section 3.5.3: Provider Caseloads
• Section 3.5.4: Staffing and Capacity Report
• Section 3.5.5: Training
• Section 4.3: Methods to Identify Potentially Eligible Members
• Section 4.3.1: Member Assignment to ECM Providers
• Section 4.3.2.1: ECM Provider Initiated Eligibility Referral
• Section 4.3.2.2: Member Initiated Eligibility Referral
• Section 4.3.2.3: ECM Community Initiated Eligibility Referrals
• Section 4.4.1: ECM Provider Conducted Outreach
• Section 4.6.2: Member Opt-in to Enroll
• Section 4.6.5.1: Provider Expectations
• Section 4.9: ECM Core Services
• Section 4.10: Program Completion
• Section 4.11.1: ECM Provider Initiated Disenrollment
• Section 4.12.3: Provision of Data/Reports from the ECM Provider to Health Net

Contact information and support

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center at 800-675-6110.

 

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

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.