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:

• Provider portal (preferred method). Log in to the secure provider portal, then select Eligibility.
• Automated Eligibility Verification System: 800-456-2387
  The Automated Eligibility Verification System (AEVS) is available from 7:00 a.m. to 8:00 p.m., seven days a week. To access this automated network, providers will need their Medi-Cal Provider Identification Number (PIN).
• Calling:
  • Health Net: 800-675-6110
  • CalViva Health: 888-893-1569
  • Community Health Plan of Imperial Valley: 833-236-4141

If you are a provider who currently does not have access to the portal, refer to the below brochure for instructions on how to register:

• Save Time Navigating the Provider Portal brochure – Health Net (PDF)
• Save Time Navigating the Provider Portal brochure – CalViva Health (PDF)
• Save Time Navigating the Provider Portal brochure – Community Health Plan of Imperial Valley (PDF)

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

• Enhanced Care Management (ECM) – Complete the following form to determine if the member qualifies for ECM:
  • Enhanced Care Management (ECM) Benefit Member Eligibility Checklists/Referral Forms – Health Net (PDF)
  • Enhanced Care Management (ECM) Benefit Member Eligibility Checklists/Referral Forms – CalViva Health (PDF)
  • Enhanced Care Management (ECM) Benefit Member Eligibility Checklists/Referral Forms – Community Health Plan of Imperial Valley (PDF)
  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.