Chronic Care Management Enrollment Status

Chronic Care Management (CCM) is a Medicare based reimbursement plan which 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.  In order to set enrollment status and determine patient enrollment status, partners will use the GET and PUT APIs listed below.

For Chronic Care Management 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 are able to 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 the PUT/patients/{patientid}/insurances/{insuranceid}/ccmenrollmentstatus call. 

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 who haven’t had a claim billed.

Record Keeping:

Note: 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: 

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