Intensive Case Management (ICM) Program

Health Plans: 

  • AmeriHealth Caritas Delaware,
  • AmeriHealth Caritas District of Columbia (ACDC),
  • AmeriHealth Caritas Louisiana,
  • AmeriHealth Caritas Pennsylvania,
  • Keystone First

Workflow: 

  • Patient Clinical Documents,
  • Practice Documents

The Intensive Case Management (ICM) program helps primary care providers identify members with chronic and/or complex medical needs.

The ICM program:

  • Promotes routine access to primary care for chronically-ill members.
  • Uses outreach to increase member appointment compliance.

Each month, the health plan sends you a list of ICM patients that may require action. For example, you may need to:

  • Adjust a claim if the claim didn't include the chronic/comorbid diagnosis codes in the member’s claims history.
  • Schedule an appointment if the member has not been seen in six months. 

This guide describes how to:  

Would you rather try the online training? Check out ICM Online Training.

Access activities for all ICM members

To access and complete the activities for all ICM members on the health plan's patient roster, follow these steps:

  1. Sign in to NaviNet. On the Workflows menu, click Practice Documents.
  2. In the Practice Documents screen, find the ICM documents by using the filter and sort options. For example: 
    1. Select the Patient Roster Report filter under Document Category.
    2. Type Intensive Case Management in the Document Tags field.
    3. Sort by Date Received, Document Title, or Document Category.
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  3. Click an ICM document that includes pending activity at the end of the title. Pending activity means:
    1. You didn't submit any claims for a member in the past six months.
    2. You submitted claims in the past six months for a member, but the claims didn't include all of the chronic/comorbid diagnosis codes in the member’s claims history.
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  4. In the document that appears, click Member Selection.
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    The system displays screens that let you search for members and complete their ICM activities.
  5. Follow the instructions to complete the activities for the ICM members. 

Access ICM activities for specific members 

To access and complete the activities for a specific ICM member, follow these steps:

  1. On the Workflows menu, click Patient Clinical Documents.
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  2. In the Patient Clinical Documents screen, find the ICM documents by using the filter and sort options. For example:
    1. Select the Patient Consideration filter under Document Category.
    2. Type Intensive Case Management in the Document Tags field.
    3. Sort by Patient Last Name, Payer, or Last Document Received.
    4. Look for a red exclamation point, which indicates the health plan requests a response from you.

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  3. Click a patient name to view the patient's documents.
  4. In the screen that appears, click Member Complex Case Management Worksheet.
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    The system displays additional screens that let you complete the member's ICM activities.
  5. Follow the instructions to complete the activities for the ICM member.

Tip

  • When you view the eligibility and benefits for an ICM member and you see Clinical Document links, click the links to view the member's clinical documents (including the ICM updates).  
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Subscribe to ICM notifications

You can elect to receive notifications when new ICM updates need your attention. Note that when you choose to receive ICM updates, you subscribe to document-related subscriptions that will send you notifications related to all types of documents, and not just ICM related documents.

  • To be notified about ICM updates, you need to subscribe to the Incoming documents requesting a response subscription.
  • To be notified about ICM's and other documents requesting a response for a patient you are running an E&B on, you should also subscribe to the Patient updates when running an E&B subscription. 

To receive ICM notifications, take the following steps:

  1. On the NaviNet toolbar, click Activity, and then click the Settings tab.
  2. Under Notify me about, select the following check boxes:​
    1. Incoming Documents
    2. Patient updates when running an E&B
  3. Under Frequency of pop-up notifications, choose how often to receive pop-up notifications. Pop-up notifications appear at the upper-right of the NaviNet screen. If you disable pop-up notifications, you can still access the notifications from the Notifications tab.

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