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Community Supports End-to-End Process

Refer a member to CS services through findhelp (recommended):

  1. Sign in or create an account by selecting Sign-up at the top right corner. Fill in your information and create a password.
    • Start member search through the eligibility tool. Select member and complete CalAIM assessment.
  2. Refer a member by contacting the CS provider directly:
    1. Find a CS provider through our provider directory:
    2. Contact the contracted CS provider and provide the member's contact and any supplemental information used to determine the member's eligibility for CS services.
    3. Contact member services.

When a referral is made, verify if the member is eligible for CS services by checking eligibility through:

Refer to the Referral and Auth for CS Providers training: CalAIM Training > Required Onboard Trainings.

CS providers will be responsible for checking the CS authorization guide to qualify the member for the CS services and submit an authorization prior to providing the services. Verify member qualifications for CS services by using CS authorization guides on the CalAIM Resources for Providers > Forms & Tools > Community Supports.

findhelp

  • CS providers will receive a referral notification letting them know they have a new referral. The referrals will automatically be added to their Inbound Referrals dashboard.
  • The member's contact information is included in the notification so that CS providers can connect with the member directly. If a comment was included at the time of the referral, that will be in the body of the email.
  • When the authorization is approved, CS providers can update the status of the referral directly from the email notification or their inbound dashboards. The updated status will be reflected in real time in each respective dashboard.
  • When the authorization is approved, we recommend CS providers notify the referring entity.
  • When a member with an approved authorization appears in your Community Supports Authorization Status File (CSASF), please update the member status in the Community Supports Provider Return Transmission File (CSPRTF). CS providers are expected to submit the CSPRTF to the Plan on a monthly basis by the 5th of the month. The CSPRTF should only include members who are on their most recent CSASF.

    Note: Adding a member to CSPRTF does not automatically generate an authorization approval.

Community Supports Authorization Status File (CSASF)

  • On an ongoing basis, the Health Plan uses data to identify members that are potentially eligible for certain Community Supports services.
  • These members will be added to provider CSASF files, transmitted to providers through sFTP on the 15th and 29th of each month.
  • Members listed on this file need to be outreached to in order for providers to assess the members eligibility for the services and gain consent to provide the service. Verify member qualifications for CS services by using CS authorization guides on the CalAIM Resources for Providers > Forms & Tools> Community Supports.

Provider to provider referrals

  • CS providers can receive referrals directly from other entities. CS provider contact information is listed in the provider directory.
  • CS providers will be responsible for checking the CS authorization guide to qualify the member for the CS services and submit an authorization prior to providing the services.
  • We encourage you to use the Community Supports Referral form to submit with your authorization: CalAIM Resources for Providers > Forms & Tools > Community Supports.
  • When the authorization is approved, we recommend CS providers notify the referring entity (refer to step 6).
  • When a member with an approved authorization appears in your CSASF, please update the member status in the CSPRTF. CS providers are expected to submit the CSPRTF to the Plan by the 5th of the month. The CSPRTF should only include members who are on their most recent CSASF.

    Note: Adding a member to CSPRTF does not automatically generate an authorization approval.

The CS provider will follow up with the member to collect their consent and all supporting documents needed for authorization. Refer to the CS authorization guides to determine what documents to submit with the authorization request. Note: Member consent can be written or verbal as long as you have a record of it. We do not have a template for consent and you are not required to submit it to us.

How do I submit authorizations?

Submit authorizations by either of the following:

For more information on how to submit authorization requests, review CS authorization guides on CalAIM Resources for Providers > Forms & Tools > Community Supports.

Training on this process can be found at CalAIM Training > Required Onboard Trainings.

How can I check the status of authorization?

You can check your authorization status through the provider portal. If you submit the authorization request by fax, it will take longer for the authorization to appear in the provider portal. If you do not have access to the provider portal, you will receive a letter after a decision is made on the authorization request by mail.

When a member with an approved authorization appears in your Community Supports Authorization Status File (CSASF), please update the member status in the Community Supports Provider Return Transmission File (CSPRTF). CS providers are expected to submit the CSPRTF to the Plan on a monthly basis by the 5th of the month. The CSPRTF should only include members who are on their most recent CSASF.

Note: Adding a member to CSPRTF does not automatically generate an authorization approval.
The standard turnaround time for authorization requests is five business days. If additional information is needed to make a prior authorization decision, our authorization team will contact you by phone or email.

The CS provider should contact the member and provide applicable services (including any additional assessments needed to provide services). Each CS requirement and documentation will vary. Refer to the CS authorization guide before providing service to the member.

 

Billing

Providers can bill CS services by submitting a claim or an invoice form.

Bill with a claim

Submit claims or invoice forms and supporting information to one of the options:

Billing training

To learn more about how to bill for CS, refer to the refer to the Claims and Invoice for Providers training: CalAIM training > Required Onboard Trainings

Additional tips

When should authorizations be submitted?

Provider TypeWhen to Submit Authorization
ECM providerIf you identify a member for ECM who is not on the Member Information File (MIF) (authorization request will generate an ECM referral).
CS provider
  • If you identify member who may qualify for CS.
  • If the member already has an approved authorization on file that needs additional units for CS services (refer to CS auth guides to determine if more units can be added).
  • If the member already has an authorization on file that's expired or soon to be expired that needs to be extended (refer to CS auth guides to determine what can be extended).
  • Refer to CS referral forms, which include required information for certain CS services.
Provider not contracted for ECM or CSIf you identify a member for ECM. The authorization request will generate an ECM referral. Please note, ECM authorization is not required so the member and provider will not receive an authorization letter. The member will receive an outreach from an assigned ECM provider.
Last Updated: 03/12/2025