CCM Enrollment
The Chronic Care Management (CCM) Enrollment feature allows the user to view the enrollment and modifications of patients with CCM eligible insurances.
The Chronic Care Management CCM Enrollment Status Changed Subscription feature will allow the user to retrieve any changes to the enrollment status. The user will need to subscribe. For more information about subscriptions, please refer Changed Data Subscriptions.
Chronic Care Management (CCM) is a Medicare-based reimbursement plan that provides a non-visit-based payment for chronically ill Medicare patients. CCM payment is available to medical practices that provide care to patients who have two or more chronic conditions that are expected to last a year or longer and who are at risk for death or functional decline.
To set enrollment status and determine patient enrollment status, partners use the GET and PUT APIs listed below. For CCM partners, we allow you to set the CCM Enrollment status for patients. The CCM Enrollment status for a patient controls a claim rule that can kick claims for procedure code 99490 into Hold if the patient is not set to enrolled status. You can set the status for a patient based on the patient’s insurance. If the insurance is deemed to be ineligible for CCM enrollment, you may not set the enrollment status for the patient. Insurance eligibility is currently restricted to the patient having Medicare Type B insurance in athenaNet.
Available CCM Enrollment statuses are specified in this call: PUT/patients/{patientid}/insurances/{insuranceid}/ccmenrollmentstatus
From a reporting standpoint, practices can run the CCM Eligible Patients Report, which can be filtered by enrollment status. They may also run the “Medicare CCM claims eligible to be created report,” which surfaces all patients with a valid CCM Enrollment Status for the timeframe the report is run and who haven’t had a claim billed.
Recordkeeping
athenaNet does not have a way to programmatically determine if a CCM Authorization form has been signed for a given patient. When setting this status, practices need to make sure an authorization form is signed and stored in the patient’s chart for audit purposes.
API calls:
PUT /patients/{patientid}/insurances/{insuranceid}/ccmenrollmentstatus
GET /patients/{patientid}/insurances/{insuranceid}/ccmenrollmentstatus
Endpoints
- Primary
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Subscription
Retrieves the Chronic Care Management enrollment status of a patient's specific insurance package
Input Parameters
Expand allOutput Parameters
Expand allModifies the Chronic Care Management enrollment status for a specific patient
Input Parameters
Expand all❙ Request Body
Expand allOutput Parameters
Expand allRetrieve list of all events that can be input for this subscription.
Input Parameters
Expand all❙ required
Subscribes for changed CCM enrollment status events
Input Parameters
Expand allOutput Parameters
Expand allRetrieves list of events applicable for CCM enrollment status changed
Input Parameters
Expand all❙ required
Retrieve list of records whose enrollment status is modified
Input Parameters
Expand all❙ required
Output Parameters
Expand allDelete an specific event which is no longer required