See the question above. providers will have to use a propriety flat file layout to submit information.   We will not accept 837 files from clearinghouses.  They must submit a billable activities import file to us which we will then turn into claims and submit on their behalf.  TBD

FCHN collects all billing requirements in EXYM.  FCHN tests claim submissions with health plans before moving the process to production.  Providers do not need to test claim submission processes as this process is owned by FCHN.

You can submit EFT information via this link: https://docs.google.com/forms/d/e/1FAIpQLSee1Jt8r-xSlyv6GurAmiKT_Djz-0KiWbLtJz01y810Ljn0SQ/viewform

Providers are strongly encouraged to utilize our EXYM EHR for all ECM, CS, and CHW activities.  FCHN bills on behalf of all of its providers.

Providers are not required to contract with all health plans that Full Circle contracts with. We hope to work with providers to pursue an all-payer strategy so you can serve all members.

Beacuse this is primarily a field-based services, you are able to provide services in a county where you do not have a phsycial office, especially if you have an office in an adjacent county.  Furthermore, many providers that operate in multiple counties are centralizing their operations for CalAIM services.

No, with Kaiser being the exception. Kaiser has delegated ECM, CS, and CHW services to its Network Lead Entities (NLEs).   Full Circle is the only NLE that works with Children, Youth, and their families for Kaiser.

Full Circle charges providers on a percent of revenue basis.

You will have one agreement for all geographies and services. As Full Circle adds more health plans in your geographies, you will get amendments to this base agreement. Our goal is to have an expansive network for all managed care plans, but it is not all or nothing. You may choose not to participate in specific health plans and not others based on rates and operational requirements.

The goal/idea is that you can contract with the NLE that represents the main portion of what you do and they can also help ensure you can deliver all the rest of the services. So in this case, if children, youth and families for ECM is your main service then you would contract with Full Circle for that, as well as CHW, ECM for adult populations and Community Supports.

Each service line has its own requirements.  Full Circle has customized its EHR to capture all of the requirements.  At a high level, each encounter, or attempted encounter with a member must be documented.  Every individual in ECM must have an assessment and care plan with actionable goals that are updated monthly. Individuals in CHW services that have used more than 12 units must have a care plan.

The ECM assessment is a comprehensive, whole person assessment that must be completed with the member, or their representative, prior to developing the Care plan.  The assessment is designed to understand the needs of the member.  The care plan outlines the specific goals that a member will be working on.  The care plan should be directly tied to the assessment and the population of focus that a member belongs to.

Yes, you can set up a user with administrative rights to review documentation. Full Circle will also be working with providers on routine audits and quality assurance practices.

There is a comprehensive list of reports available through EXYM.  They are self service.

The initial agreement to enroll in ECM is captured by the person conducting Outreach (in most cases this is Full Circle).  However, a consent to release information is required when talking with other entitties that are involved in the member's care. Upon engagement, the ECM Provider shall obtain the client’s written consent using the Release of Information prescribed for use in the county the Provider operates.

Member consent may be obtained electronically or via paper form but in each case, the form must be uploaded into the member's EHR and available upon request from FCHN.

For existing client referrals (community pathway referrals), it is the responsibility of the provider to check for client eligibility and to obtain agreement to enroll in ECM before submitting the referral. Providers should utilize the ECM Screening Checklist located in the FCHN Onboarding packet before submitting the referral to FCHN.

For referrals received by the health plan, Full Circle will be responsible for client registration and eligibility verification.

There are two pathways for referrals.  The first is via the health plan and the second is community pathway referrals (or referrals that the provider obtains from its existing clients or referral pathways.)

Full Circle receives the monthly member information file from the health plan.  Full Circle is responsible for outreaching and engaging the members.  Once members have agreed to engage in ECM services, they are assigned to our network of providers using an algorithm that takes into account POF, location, language, and capacity.

DHCS has stated it projects a total penetration rate of ECM for youth Medi-Cal populations at about 1.25% of enrollment. However, all children who meet the criteria for specialty mental health services, SUD services, child welfare and justice involved are eligible. Unlike with the adult population, youth do not have to have complex medical comorbidities.

Informal placement does qualify under the child welfare category; however, there are multiple POFs that could render them eligible for services.  This will be a good fit.

Referrals can occur in two ways: 1) Providers requesting authorization from the MCP for known/existing clients; and 2) MCPs referring to FCHN which will then assign to a provider. FCHN plays an intermediary role in both processes.

In addition to location, FCHN has developed an algorithm that assigns referrals based on the following: provider capacity, population of focus, client ages served and language preferences.

All engagements with members and attempts to engage members need to be documented in EXYM.

Most health plans send 90% of their referrals in the first MIF.  The number of referrals in a MIF vary by Health Plan. Because those referrals are not vetted with the member, the conversion rate from referral to members who engage in services is approximately 12%.  This experience has really highlighted the importance of Community Pathway Referrals.   Not only does it allow providers to own their expansion rate and growth, but we are seeing over 80% or those members converting to ECM.

It varies, and we would work with you each month to understand your capacity and build it up. That is one of the nice features of working with FCHN.

We believe the outreach assistance is one of the greatest assets to working with FCHN and were curious to what extent that varies across the FCHN providers Right now net new referrals have an 12% conversion rate across our plans for referrals than originated on the MIF. We are implementing additional mechanisms to improve that rate, but our experience and other health plans experience is that internal referrals are the best way to increase volume. Our conversion rate across community pathway referrals are much higher- closer to 80%.

If you follow the community pathway process and speak to the member and make sure they are eligible for services with the health plan prior to submitting your referrals, you are assuring a much higher conversion rate.

We do not yet have enough data to speak confidently on attrition rates.

The MCPs provide an authorization for 12 months, but the expectation is that you are constantly assessing goals and needs to determine when a client is appropriate for discharge.

This varies by health plan.

The provider will receive the outreach payment if they conducted the outreach, or if the member agreed to enroll in ECM.

The health plan is the only one who can assign a tier.  It may change at any time.

Full Circle has contracted with Exym to be the EHR for providers. Full Circle has configured Exym to meet all requirements for ECM services and this is the only system providers will need to use.

Case Manager (LCM) - primarily responsible for entering client data and progress notes, care plans and assessments.Clinician - may enter notes, care plans and assessments in addition to co-signing other's care plans and assessments.Supervisor - May review/approve Case Manager and Clinician notes and review member charts.

The ECM Provider Comprehensive Risk Assessment and the Individualized Care Plan are built into the system. Depending on the plan, there may be additional external forms to complete for clients that should also be uploaded into the system.

Data Collection and Reporting. FCHN will provide shared infrastructure and technical assistance for data collection and reporting to meet Payor contractual and regulatory requirements.

No, providers do not have to double document. Full Circle is in the process of building out interoperability.  There is a workaround process in place during our buildout of full interoperability capabilities.  The expectation is if a provider is not documenting in EXYM, they will participate in the required exchange of information.

Every provider will be required to participate in overview trainings, system demonstrations, and service specific trainings.  There will be additional supports available to all providers including office hours, IT tickets, and direct contact with FCHN representatives, with the goal being provider success.

Yes, training is part of Full Circle's administrative services and included in the base payment.  Trainings, desk references, and user guides will be available to providers 24/7 on our learning management system.