Community Based Adult Services (CBAS)

CBAS
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History | Our Philosophy | Care1st Contacts for CBAS Questions

History

Care1st Health Plan (“Care1st”) was established as a California corporation, in 1994, by three Traditional Safety Net provider groups and two disproportionate share hospitals, all with extensive experience in providing health care services under government sponsored and commercial health care programs.

Today, Care1st provides health care benefits to a combined membership (Medi-­Cal, Dental, Medicare, Healthy Families and Commercial) of approximately 400,000.

Our Philosophy

Mission
Care1st Health Plan will be the most provider-­oriented managed care  organization that will strive to continuously improve the quality of services  rendered to its Members.

 Vision
Care1st Health Plan will be the leader in innovation utilizing advanced   technology to achieve excellence in customer satisfaction for members,  providers, and employees.

 Values
Care1st Health Plan is committed to basic moral and ethical values driven  by integrity, honesty, and respect for all.

Care1st Contacts for CBAS Questions

Questions about CBAS Referrals and Authorizations?

  • Please contact Our CBAS Intake Team Direct Line at: 1-855-622-2755

Questions about CBAS Contracts?

  • Please contact Amabelle Holgado at: 1-800-605-2556 ext. 6682

Questions about CBAS Claims?

  • Please contact Michael Huynh at: 1-800-605-2556 ext. 6229

CBAS Referral Process


New CBAS Referrals – Standard

  1. Inquiry is sent to Care1st CBAS Intake Department:
    Voice: (855) 622-2755 (All Counties)
    FAX: (855) 699-9876 (Los Angeles) / (855) 699-9877 (San Diego)
  2. Care1st pre-screens the inquiry for eligibility: Active Medi-Cal, Care1st Assignment, Age ≥18.
  3. If the member is found not to be eligible, Care1st will notify the requesting party and the member of ineligible status.
  4. If member is eligible, a letter acknowledging receipt of the inquiry will be mailed to the requesting party and the member within five (5) business days.
  5. Care1st will contact a Home Health Provider within five (5) business days of referral to schedule the Face-to-Face CBAS Eligibility Determination Tool (CEDT) assessment.
  6. A Home Health RN will contact the member directly to schedule the CEDT assessment.
  7. If the Home Health RN is initially unable to reach the member, two additional attempts will be made.
  8. If the Home Health RN is unable to reach the member following three unsuccessful attempts, the Home Health Provider will notify Care1st.
  9. Care1st will send out a letter to the member explaining that he or she will have only until the 14th day from the receipt of the initial referral to schedule the CEDT.
  10. If the member fails to contact Care1st to schedule the CEDT within the 14- day period, Care1st will send a letter to the member explaining that a new referral will need to be submitted again if CBAS services are still being sought.
  11. The CEDT assessment will be completed within thirty (30) days of receiving the referral.
  12. After reviewing the CEDT, the decision regarding the eligibility for the Individual Plan of Care (IPC) will be FAXed to the CBAS Provider within one (1) business day of the decision.
  13. Upon receiving notification of eligibility for the IPC to be conducted, the CBAS Provider will complete the 3-day IPC assessment.
  14. A prior authorization request and the IPC will then be submitted to Care1st.
  15. Care1st will accept, modify, or deny the authorization request within five (5) business days. A 14-day letter of delay will be sent to the member and the CBAS facility if the decision is not reached within the five (5) business days.
  16. Upon reaching a decision, Care1st will FAX the decision to the CBAS facility within 24 hours. The member will be contacted within 48 hours.
  17. The written notification is sent to the member, the CBAS facility, as well as the requesting provider.

New CBAS Referrals – Expedited

  1. Skilled Nursing Facility (SNF) or Hospital submits the inquiry to the Care1st CBAS Intake Team:
    Voice: (855) 622-2755 (All Counties)
    FAX: (855) 699-9876 (Los Angeles)/ (855) 699-9877 (San Diego)
  2. Care1st will authorize a Home Health RN to schedule the CEDT assessment at the SNF/hospital within five (5) days of the referral.
  3. Care1st will contact the requesting party and the member regarding the decision of the CEDT within one (1) business day.
  4. CBAS Provider conducts the IPC assessment with the member.
  5. Following the IPC assessment, the CBAS Provider submits authorization request along with the IPC to Care1st.
  6. Care1st will review the authorization and the IPC, then approve, modify, or deny the authorization request within 72 hours.
  7. Care1st will notify the CBAS facility by FAX within 24 hours. The member will be notified within 48 hours.
  8. Care1st will send the letter of approval, modification, or denial to the CBAS provider, the member, and the requesting party.

Re-Authorization Requests for Existing CBAS Participants

  1. Prior Authorization Request, along with the updated IPC, is submitted to Care1st.
  2. Care1st will review the Authorization Request and approve, modify, or deny the request within five (5) business days. A 14- day letter of delay will be sent to the member and CBAS facility if the decision is not reached within the five (5) business days.
  3. If the decision is reached to decrease the services or to deny the authorization altogether, a Face-to-Face CEDT assessment will be conducted by a Home Health RN.
  4. Following the determination of the CEDT, Care1st will notify the CBAS provider by FAX within 24 hours of the decision. The member will be contacted within 48 hours.
  5. Written notification of the decision is sent to the member, the CBAS provider, and the requesting party.

Care1st Member Services

Participants have questions about their coverage or benefits?
Need to verify eligibility with Care1st?

Please call 1(800) 605-2556

Claims Submission

Claims can be submitted via the following:

  • For Paper Claim submission:
Form: UB-04
  • All required information must be included such as:
    • TIN must be included in FL 5
    • Billing NPI must be included in FL 56
    • Authorization number must be included in FL 63
    • Services must be billed using revenue code “3103” and applicable HCPCS codes:
    • HCPCS CodeDescription
      H2000Comprehensive multidisciplinary evaluation
      S5102Day care services, adult; per diem
      T1023Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
Submit claims to:
Care1st Health Plan
Mail Stop CL001
601 Potrero Grande Dr
Monterey Park, CA 91755
  • For Electronic Claims (837I):
    Submit all required information such as items noted Paper Claim submission.

    Providers have the option to submit either through Emdeon or Office Ally. Claims may be submitted on a weekly, bi-weekly, or monthly basis.
Emdeon
Payer ID – 57115
(877) 363-3666
www.emdeon.com
Office Ally
Payer ID – C1SCA
(866) 575-4120
www.officeally.com

Claims with attachments must be submitted by paper. Providers who wish to submit claims attachments electronically must contract with RISARC. RISARC will forward the attachments to Care1st electronically.

RISARC
303 N. Glenoaks Blvd, Suite 660
Burbank, CA 91502
Phone: (818) 953-3020
Fax: (818) 953-3011
Email: iyu@risarconline.com | Website: www.risarc.com

*Claims must be submitted within 90 days after the date of service as a condition for payment.

Care1st Claims Department

Questions about a claim?
Please contact our Claims Department:
1-800-605-2556 ext. 6132

Appeals Process


Care1st CBAS Process – Member Appeals/Grievances

Members or members' representatives have the right to file an appeal or grievance


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