To refer a member for care management, call 1-800-493-0040.
The goal of the program is to help members regain optimum health or improved functional capacity in the right setting, utilizing the right providers, in the right time frame and in a cost-effective manner. It involves comprehensive assessment of a Member’s condition, to include but not limited to, determination of the available benefits and resources, and development and implementation of a Care Management Plan with performance goals, monitoring and follow-up. More specifically, the goals established for the Complex Care Management (CCM) Program include:
The goals of the Complex Care Management Program are to:
The following criteria are used to determine which Members will benefit from the CCM Program. Program criteria were established to provide the opportunity to participate in Complex Care Management for Members with a variety of complex conditions.
Factors distinguishing Complex Care Management typically include a degree of complexity of illness or condition that are severe, requiring a level of management that is intensive and requiring an extensive amount of resources to obtain optimal health or improved functioning. Eligibility will start the date the Member is identified as being eligible for CCM services. Enrollment occurs when the Member has provided consent to receive services.
CCM is a voluntary program, so only Members who agree and consent to the program are enrolled.
AND one or more of the following needs: