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Click ‘Get Form’ to open the case management PCCM form in the editor.
Begin by filling out the Primary Care Provider Information section. Enter the provider's name, contact name, telephone number, NPI, and TPI.
Next, complete the Client Information section. Input the client's name, Medicaid number, date of birth, referral date, and telephone number.
If applicable, provide details in the Referring Provider Information section. Include their name, contact name, telephone number, NPI, and TPI.
In the Consulting Provider/Facility section, enter the provider/facility name, telephone number, address, appointment time and date. If known, include the Medicaid number.
Specify the reason for referral and select appropriate options for care authorization. Ensure to check all relevant boxes.
Finally, add any consultant comments and ensure that both consultant signature and date are filled out before submission.
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PCCM is primary care case management. PCP is primary care provider.
What is the difference between MCO and PCCM?
MCO refers to risk-based managed care; PCCM refers to Primary Care Case Management. FFS/Other refers to Medicaid beneficiaries who are not in MCOs or PCCM programs.
What does PCCM stand for?
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service
What is a PCCM in family medicine?
The patient-centred clinical method (PCCM) is a conceptual approach to providing health care, is characterized by a full exploration of the patients concerns within the context of their lives and mutually agreeing on the path forward, all within strong relationships with the health care team.
case management referral examples
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Case managers will utilize a fillable PDF form provided by HCPF for any new Rights Modifications or changes to existing Rights Modifications, post Go Live, and
Person-Centered Case Management (PCCM) Certificate
The six-course Person-Centered Case Management (PCCM) certificate, with 24 CEs, is an alternative to our five-course Case Management Certificate, with 20 CEs.
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