FAQ Directory: Health Plan Accreditation

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2.15.2018 Identifying a member for Complex Case Management When is a member identified as eligible to receive complex case management services?

A member is identified to receive complex case management services in PHM 2, Element D. The organization’s policies and procedures describes its method for categorizing membership for involvement in complex case management. Once identified, the organization must begin the initial assessment within 30 days and complete within 60 days to meet the PHM 5, Element D requirement.

HP 2018