Street Medicine End-to-End Process

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.
• Calling Provider Services at 877-658-0305.

Verify if the member qualifies for any of the below services:

• Enhanced Care Management (ECM) – Complete the Enhanced Care Management (ECM) Benefit Member Eligibility Checklists/Referral Forms (PDF) form to determine if the member qualifies for ECM.
  
  Refer to the Referral and Auths Guidance for ECM Providers training on the CalAIM Provider Training page for more information on referrals.
• Community Supports (CS) – Verify member qualifications for CS services by using CS authorization guides. If the member qualifies for CS services, refer to the CS workflow for referral information.
• Community Health Worker – A physician or other licensed practitioner can recommend Community Health Worker services if a member meets eligibility criteria. A recommendation is required for Community Health Worker services.

Coordinate member care with the member's primary care physician (PCP) and/or participating physician group (PPG) and initiate specialist referrals, including behavioral health, Community Supports and social services, when needed.

Submit claims 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.

Note: Authorization number is not a required field for billing.

For more information on billing for street medicine refer to the Department of Health Care Services billing guidelines.

Billing training

To learn more about how to bill for street medicine services, refer to the Claims and Invoice Guidance training.

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