California ECM Operations Readiness Checklist

We can accept a referral with incomplete member information and preserve its source and original submission.

We can record one referral with separate requested ECM and Community Supports items where needed.

We check for duplicate member records and an existing active ECM enrollment before starting another.

We capture the relevant DHCS referral fields and route the referral using our plan's current process.

Each referral has an owner, next action, due date, and visible outreach history, including unsuccessful attempts and reasons for closure.

We record the applicable population of focus and supporting evidence without treating our software as the final eligibility authority.

We keep referral, authorization, program enrollment, and service delivery statuses separate.

We track authorization dates, service periods, renewals, plan responses, and escalation.

We know whether streamlined authorization applies to our provider, population, plan, and arrangement, and we track its referral and decision deadlines when applicable.

We document program overlaps and coordinate non-duplication where another care management program is involved.

Adult and Children and Youth programs use appropriate assessments, care plans, relationships, staff roles, and transition processes.

Children and Youth records capture parent, guardian, caregiver, or authorized representative context where applicable.

We can show the lead care manager, care team, current goals, interventions, member preferences, progress, and reassessment date.

We can identify the ECM core service component, activity, staff member, date, modality, duration, and supporting note for delivered work.

We have a process for missed contacts, overdue care plans, closed-loop follow-up, and transitions of care.

We know which Community Supports our plans offer in our counties and which services we contract to deliver.

ECM and Community Supports can share member context while keeping separate authorizations, service definitions, documentation, and billing records.

We track each Community Supports referral and its response and avoid assuming ECM enrollment is required for every Community Support.

Each contract's codes, modifiers, place of service, staff requirements, units, thresholds, rates, reimbursement method, and effective dates are documented and tested.

We do not apply one provider's monthly unit threshold or reimbursement method to all California plans.

A biller can see which service or month is ready, which is on hold, why, and what correction is needed.

Claims or invoices receive the required review and approval before submission.

We know the accepted trading-partner path for each contract and distinguish 837P provider claims from the MCP's encounter reporting to DHCS.

We can track rejections, denials, corrections, timely filing, 835 remittances, adjustments, expected amounts, paid amounts, and underpayment follow-up where applicable.

Intake, care management, supervision, billing, and leadership can each see the exceptions they own.

We can trace a reported result to its referral, authorization, care plan, service note, claim or invoice, payment, and applicable rule.

We have a reproducible way to assemble requested records for a plan or auditor and identify missing evidence.

We confirm the plan's requested data and file process; we do not assume our provider sends monthly ECM JSON directly to DHCS.

Access, consent, data sharing, retention, export, and security practices are documented and approved by our organization.