Community Supports End-to-End Process

When a referral is made, verify if the member is eligible for CS services by checking eligibility through:

• Provider portal: Log in and select Eligibility Verification under Provider Resources
• Department of Health Care Services Medi-Cal eligibility website

Refer to the Referral and Auths Guidance for CS Providers training located on the CalAIM Provider Training page. Scroll down to CalAIM Provider Training to see the steps to check eligibility and submit authorizations through the provider portal.

In addition to CS referrals, CS providers may also receive a Community Supports Authorization Status File (CSASF) on the 15th and 29th of each month that includes members who are currently assigned to them with an authorization and potential CS members for outreach.

Verify member qualifications for CS services by using CS authorization guides on CalAIM Resources for Providers > Forms & Tools.

CS providers may receive referrals through findhelp or other means.

findhelp

• CS providers will receive a referral notification letting them know they have a new referral. The referrals will automatically be added to their Inbound Referrals dashboard.
• The member's contact information is included in the notification so that CS providers can connect with the member directly. If a comment was included at the time of the referral, that will be in the body of the email.
• CS providers will be responsible for checking the CS authorization guide to qualify the member for the CS services and submit an authorization prior to providing the services (refer to step 5).
• When the authorization is approved, CS providers can update the status of the referral directly from the email notification or their inbound dashboards. The updated status will be reflected in real time in each respective dashboard (refer to step 6).
• When a member with an approved authorization appears in your Community Supports Authorization Status File (CSASF), please update the member status in the Community Supports Provider Return Transmission File (CSPRTF). CS providers are expected to submit the CSPRTF to the Plan on a monthly basis between the 5th through the 10th. The CSPRTF should only include members who are on their most recent CSASF.
  
  Note: Adding a member to CSPRTF does not automatically generate an authorization approval.

Other means

• CS providers can receive referrals directly from other entities by using the contact information listed in the provider directory or potential members identified through CSASF.
• CS providers will be responsible for checking the CS authorization guide to qualify the member for the CS services and submit an authorization prior to providing the services (refer to step 5).
• When the authorization is approved, we recommend CS providers notify the referring entity (refer to step 6).
• When a member with an approved authorization appears in your CSASF, please update the member status in the CSPRTF. CS providers are expected to submit the CSPRTF to the Plan on a monthly basis between the 5th through the 10th. The CSPRTF should only include members who are on their most recent CSASF.
  
  Note: Adding a member to CSPRTF does not automatically generate an authorization approval.

The CS provider will follow up with the member to collect their consent and all supporting documents needed for authorization. Refer to the CS authorization guides to determine what documents to submit with the authorization request. Note: Member consent can be written or verbal as long as you have a record of it. We do not have a template for consent and you are not required to submit it to us.

How do I submit authorizations?

Submit authorizations by either of the following:

• Online (recommended): Go to the provider portal and log in.
• Fax: Complete the prior authorization request and fax it to 866-724-5057. The authorization form can be found at the Prior Authorization webpage.

For more information on how to submit authorization requests, refer to the Referral and Auths Guidance for CS Providers training located on the CalAIM Provider Training page.

Note: The training deck is available after viewing the training video.

How can I check the status of authorization?

You can check your authorization status through the provider portal. If you submit the authorization request by fax, it will take longer for the authorization to appear in the provider portal. If you do not have access to the provider portal, you will receive a letter after a decision is made on the authorization request by mail.

When a member with an approved authorization appears in your CSASF, please update the member status in the Community Supports Provider Return Transmission File (CSPRTF). CS providers are expected to submit the CSPRTF to the Plan on a monthly basis between the 5th through the 10th. The CSPRTF should only include members who are on their most recent CSASF.

Note: Adding a member to CSPRTF does not automatically generate an authorization approval.

Note: The standard turnaround time for authorization requests is five business days. If additional information is needed to make a prior authorization decision, our authorization team will contact you by phone or email.

The CS provider will contact the member to complete necessary screenings or assessment before rendering services. Each CS requirement and documentation will vary. Refer to the CS authorization guide before providing service to the member.

Billing

Providers can bill CS services by submitting a claim or an invoice form. Note: If you submit a claim, you won't have to submit an invoice and vice versa.

Bill with a claim

Submit claims using one of the following:

• Electronic data interchange (EDI) through a clearinghouse or Availity (recommended).
• The CMS-1500 (version 02/12) form for paper claims. Refer to the Claims Procedures section for more information.

Bill by invoice

Complete and submit Invoice forms:

• Download the Invoice form from the Claims Procedures section.
• Submit by email, mail, fax or Conduent portal:
  • 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
  • Conduent Web Portal

Billing training

To learn more about how to bill for CS services, refer to the Claims and Invoice Guidance for CS Providers training on the CalAIM Provider Training page.

Note: The training deck is available after viewing the training video.