Community Health Worker End-to-End Process
Click on the steps to view the process workflow for Doula services.
The member must be active and enrolled in the Medi-Cal Plan. Confirm member eligibility for the month of service through either of the following:
- The provider portal (preferred method). Log into the secure provider portal, then select Eligibility.
- The Automated Eligibility Verification System (AEVS) on the Department of Health Care Services Medi-Cal eligibility website. Use AEVS if you do not have access to the provider portal.
Check for Enhanced Care Management (ECM) flag in provider portal. If the member is already in ECM, they cannot quality for Community Health Worker services.
The member must have a recommendation on file from a physician or other licensed practitioner of the healing arts.
If you are a supervising provider for Community Health Worker services, complete and submit the recommendation by logging in to the provider portal >Eligibility, enter Member ID or Last name and DOB, then select Check Eligibility to access members record. Select Referral to document the recommendation.
If the provider does not have access to the provider portal, download the Medi-Cal Member Recommendation Community Health Worker Services form (PDF).
The physician can give the completed Medi-Cal Member Recommendation for Community Health Worker Services form to the member who can provide it to the Community Health Worker. The Community Health Worker and/or supervising provider will document the recommendation form in the member’s record and keep recommendation on file.
If the member qualifies for CS services, refer to the CS workflow for referral information.
The supervising provider must complete a care plan for member receiving over 12 units and keep the care plan on file for the member.
Once the care plan is developed, the supervising provider must go to provider portal and attest to a care plan. (Pending).
Member care plan needs to be assessed every six months after initial date of care.
Providers can bill through claims submission or invoice submission. If you submit claims, you won’t have to submit an invoice and vice versa.
Submit claims or invoice forms and supporting information to one of the options below:
- Electronic data interchange (EDI) through a clearinghouse or Availity (recommended).
- Submit paper CMS-1500 (version 02/12) form for paper claims. Refer to the Claims Procedures section for more information.
- Bill by invoice
Email: CalAIM_CS_invoicesubmission@centene.com
Address: California Health and Wellness Plan – CalAIM Invoice, PO Box 10439, Van Nuys, CA 91410-0439
Fax: 833-386-1043
Billing training
To learn more about how to bill for Community Health Worker services, refer to the Claims and Invoice Guidance training.
Note: The training deck is available after viewing the training video.