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Questions?
Just call us at 1-855-772-9076 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.
What is CalAIM?
CalAIM (California Advancing and Innovating Medi-Cal) is a multi-year initiative led by the Department of Healthcare Services (DHCS). The program aims to promote the health and well-being of Medi-Cal recipients by implementing delivery system and payment reforms across the program.
By leveraging Medicaid as a tool, CalAIM helps address many of the complex challenges facing California’s most vulnerable residents. It takes a person-centered approach that targets social determinants of health and reduces health disparities and inequities.
Note: Whole Person Care (WPC)/Health Homes Program has transitioned to Enhanced Care Management (ECM)/Community Supports (as of January 1, 2022).
What are the key populations of focus?
What are the key populations of focus?
CalAIM ECM services focus on those who fall within these specific groups:
- High utilizers
- Homeless
- Transitioning from incarceration
- Individuals at risk for institutionalization
- Adults: serious mental illness (SMI) or substance use disorder (SUD)
- Children: SMI, serious emotional disturbances (SED) or SUD
- People eligible for long-term care primary care provider (LTC PCP), specialist or group
- Nursing facility residents who want to transition to the community
- Children or youth with complex health needs (examples: California Children’s Services (CCS), foster care, etc.)
Aetna Better Health® of California offers members these Community Supports services:
Housing transition/navigation services
Housing deposits
Housing tenancy and sustaining services
Short-term post-hospitalization housing
Recuperative care (medical respite)
Respite
Day habilitation programs
Nursing facility transition/diversion to assisted living facility
Nursing facility transition to home
Personal care and homemaker services
Environmental accessibility adaptations
Meals/medically tailored meals
Sobering centers
Asthma remediation
How do you request prior authorization?
You can submit PA requests by:
Fax: 860-900-1779
ECM referral forms:
PA decision turnaround times
Urgent pre-service approval: within 72 hours from receipt of request
Non-urgent pre-service approval: within 5 calendars days from receipt of the request
Post-service approval: within 30 calendar days from receipt of the request
To see additional time frames, you can refer to your provider manual (PDF).
More resources and information
Providers who can’t submit compliant claims electronically may instead submit invoices to Aetna Better Health of California.
New invoice submissions
Must be submitted within 180 calendar days from the date the service unless there is a contractual exception
Invoice resubmission
- Must be filed within 90 days from the date of adverse determination of an invoice
- Providers may resubmit an invoice that was originally denied because of:
- Missing documentation
- Incorrect coding
- Processing errors which resulted in the invoice being incorrectly labeled as paid or denied
- Providers may resubmit an invoice that was originally denied because of:
How to submit an invoice
To submit an invoice, providers must use the approved ECM/Community Supports invoice template (PDF).
Be sure to include this information with the invoice:
Member’s name, date of birth and Aetna® member ID number
Date(s) of service(s) provided
Service(s) provided
Provider information
Ready to submit?
You can send your completed invoice to us via email.