22-126m Enhanced Care Management (ECM) Eligibility Reports Help You Best Serve High-Cost, High-Need Members
Date: 02/14/22
Use the whole-health approach to deliver comprehensive care
California Health & Wellness Plan (CHWP) 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 CHW 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. 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 CHWP’s provider portal by following the steps below
- Log on to the provider portal.
- Log in with your cahealthwellness.com email and password.
- Select Provider Reports under Welcome.
- Select CA_ECM_123456789_PYCCYY_MM.csv 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 with frequent hospital admissions, short-term skilled nursing facility stays, or emergency room visits |
Adult – co-occurring chronic health conditions plus 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 (LTC) services |
Adult – nursing facility resident 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 |
Additional information
Providers are encouraged to access CHWP’s 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 CHWP at 877-658-0305.