Requirements
The CM Triage assessment is required to be completed when which opportunities are identified?
What are: high risk dailies, high risk monthlies, medium risk monthlies, and complex opportunities.
When does the CM Triage assessment have to be completed?
What is within 60 calendar days from the original date of High Risk/Complex identification.
If continued case management is needed/anticipated past 30 days what must the CM do?
What is the CM will triage as High Risk / Complex and answer “Yes” to question 10, will you be treating as High Risk /Complex”.
When must the CM Triage assessment be initiated?
What is, within 30 calendar days from the date the member is originally identified with a High Risk/Complex opportunity.
Per NCQA, what documentation is required in an SOE note if the member has gaps in care such as a need or an area of concern that could potentially impact the ability to meet the member’s goals?
What are an explanation of details, follow up plan, and a conclusion.
Per NCQA guidelines, the CM is to evaluate and document in an SOE note what on the initial member evaluation/call?
What are caregiver resources.
- If unable to initiate the assessment on the first call, the CM will need to thoroughly document the reason/rationale and document the plan for follow up on the next call.