How to Refer Members to Enhanced Care Management (ECM) and Community Supports Services

Tips for a successful referral

• When referring a member to Community Supports services, include all social factors, housing history and/or safety concerns.
• When referring a member to ECM services, always select and document the correct population of focus (POF).
• Referrals are accepted through a "no wrong door" approach. We accept all incoming referrals.
• Check back regularly for updated referral forms and eligibility groups.

Processing referrals and timelines

The Alliance processes submitted ECM/CS referrals within 5 business days, after which we will contact the referrer to let them know the outcome of the referral.

There are five possible outcomes:

• The referral is approved: Confirmation is sent to requesting and servicing providers.
• The referral is approved as modified: Correspondence is sent to the servicing and requesting provider, and a notice is sent to the member. This may happen if the request is for multiple services and only meets criteria for one, or if the dates requested do not align with the criteria.
• The referral is denied: Notice is sent to providers and the member if eligibility criteria are not met. This may happen if the member does not meet the criteria to be referred or does not fit into one of the ECM/CS populations of focus.
• The referral is pending: Referral is on hold until missing details are submitted. The Alliance will reach out to the provider to request missing information.
• The referral is voided: This only occurs if there is not enough information to process the referral. The Alliance ECM team will make attempts to obtain the missing information. Once the authorization has been pending for five business days with no additional information provided, it is voided. Correspondence is sent to the requesting provider.