Issued: November 18, 2022

What is happening?

The soft launch of Tailored Care Management (TCM) begins Dec. 1, 2022, and runs through March 31, 2023. This means most members currently receiving Community Navigator/Community Guide services (Innovations or (b)(3)) will begin Tailored Care Management on Dec. 1.

What does this mean for providers?

Most members who receive TCM will not be able to receive Community Navigator/Community Guide services as they are duplicative services.

  • Members who self-direct at least one service using Agency with Choice (AWC) or Employer of Record (EOR) may continue receiving Community Navigator/Community Guide services and TCM.
  • Members currently receiving Community Navigator/Community Guide will be able to continue the service until March 31 if they opt out of Tailored Care Management.

The table below outlines the Procedure Code/Service and End Date. Further transition/crosswalk information follows the table.

Procedure Code/Service End Date
T2041 U1 U4 – (B3) Community Guide – Periodic 11/30/2022
T2041 U4 U5 – (B3) Community Guide – Monthly 3/31/2023
T2041 U4 YI – (B3) Community Guide Annual Information Session 3/31/2023
T2041 U4 YI EO – (B3) DI Community Guide Annual Information Session Empl of Rec 3/31/2023
T2041 U4 – (B3) DI Community Guide – Monthly 3/31/2023
T2041 GT CR – Community Navigator Monthly 11/30/2022
T2041 YI EO – Community Guide Annual Information Session on Self Direction Empl of Rec 11/30/2022
T2041 Community Navigator Monthly 11/30/2022
T2041 GT – Community Navigator Monthly Telehealth 11/30/2022
T2041 U1 – Community Navigator Start Up Training 11/30/2022
T2041 U1 GT – Community Navigator Start Up Training Telehealth 11/30/2022
T2041 U2 – Community Navigator EOR Training Monthly 11/30/2022
T2041 YI – Community Navigator Annual Information Session on Self Direction 11/30/2022

Transition/Crosswalk Information (See chart below for new codes referenced):

  • Innovations and (b)(3) DI members who are NOT self-directing at least one service using AWC or EOR: Partners will end date authorizations for these services effective Nov. 30, 2022.
  • Innovations and (b)(3) DI members who ARE self-directing at least one service using AWC or EOR: Partners will crosswalk the service to a new service code effective Dec. 1, 2022, and enter an authorization through the end date of the current authorization period.
  • (b)(3) members who have chosen TCM: Partners will end date authorizations for these services effective Nov. 30, 2022. During the soft launch there may be overlap of (b)(3) Community Navigator and TCM to allow billing in the same month for one month to promote a warm handoff.
  • (b)(3) members NOT receiving TCM: These members will continue to receive T2041U4 until the member engages with TCM or the Tailored Plan launches, whichever comes first.
CURRENT SERVICE CODE ENDING 11/30/22 CROSS WALK and NEW DEFINITION in ALPHA EFF 12/1/22 CROSS WALK/NEW SERVICE CODE EFF 12/1/22
T2041 Community Navigator Monthly Community Navigator Monthly T2041 Community Navigator TCM Opt-Out Monthly

OR

T2041 EO Community Navigator Monthly AWC and EOR

T2041 GT – Community Navigator Monthly Telehealth Community Navigator Monthly T2041 GT – Community Navigator TCM Opt-Out Monthly Telehealth

OR

T2041 GT EO – Community Navigator Monthly AWC and EOR Telehealth

T2041 U1 – Community Navigator Start Up Training Community Navigator Start Up T2041 U1 – Community Navigator AWC Start Up Training
T2041 U1 GT – Community Navigator Start Up Training Telehealth Community Navigator Start Up T2041 U1 GT – Community Navigator AWC Start Up Training Telehealth
T2041 U2 – Community Navigator EOR Training Monthly Community Navigator Start Up T2041 U2 – Community Navigator EOR Start Up Training

OR
T2041 U2 GT – Community Navigator EOR Start Up Training Telehealth

T2041 YI – Community Navigator Annual Information Session on Self Direction Community Navigator Start Up T2041 YI – Community Navigator Annual Information Session on Self Direction

For Innovations: when Community Navigator Monthly is requested, the care manager will choose the Community Navigator Monthly Definition and the ALL code. This allows  the flexibility to bill any of the codes under this definition. (For example, if one month the provider needed to use telehealth they could bill T2041GTEO without seeking an additional authorization.)

Provider Network will add the new codes to the provider contracts for existing Community Navigator providers.

Who should providers contact with questions?

Please contact the I/DD UM Workgroup at 704-884-2605 or email UMQuestions@partnersbhm.org if you have further questions.