For more information on what constitutes a core service, please consult the following documentation:
- Health Homes Billing Policy and Guidance Manual (pg. 14 & 24-25)
- Health Homes Provider Qualification Standards For Chronic Medical and Behavioral Health Populations
- April 2012 New York State Medicaid Update introducing the Health Homes Program
- Core Service and In-Person Requirements for HHSC
Core Services and Encounter Types. In FCM, only certain encounter types allow a core service to be indicated. For example, during enrolled segments, an “In-Person - Met with Patient - Visit at Home” encounter may have a core service indicated, but an “In-Person - Did not meet with anyone” or “Phone - Did not reach anyone” encounter will not allow the user to indicate a core service.
A full list of encounter types and their corresponding core service rules can be found in the article "Encounter Types and Core Service".
Core Services during Outreach. Implicitly, the definition of what constitutes a core service changes during outreach segments. For this reason, for individuals in outreach status, FCM allows users to indicate a core service on nearly all encounter types, including “unsuccessful” outreach attempts, such as “Telephone – Not Contacted.” The only encounters that are not able to save successfully with a core service attached during outreach are mail encounters. Regardless of core services rendered in Outreach, members in this type of segment are not eligible for billing.
Core Services during Diligent Search. If a member is in Diligent Search, there must be at least three encounters recorded in Foothold for a given month in order to bill. In order to submit a billing support questionnaire for members in diligent search, you will choose “Yes: Diligent Search” in the Core Service Provided section of the BSQ. If there are not three encounters noted for that member month, when selecting “Yes: Diligent Search,” Foothold Care Management will alert the user and prevent the BSQ from being saved with the current selection. See this article for more details around child members and Diligent Search.
Questions?
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