Our thoughts on all things electronic case management.
In California, TCM, a Medicaid benefit program, is administered by the California Department of Health Care Services (DHCS). The TCM program started in 1995 after the Medi-Cal Administrative Claiming Program split in two: TCM and Medi-Cal Administrative Activities (MAA).
Targeted Case Management (TCM) audits help ensure that Medicaid services for individuals with serious mental illness or developmental disabilities are medically necessary and meet state and federal requirements. However, these audits can be complicated and require specialized knowledge to navigate. The top three reasons why TCM audits fail are inadequate documentation and record-keeping, inadequate training and supervision of staff, and lack of compliance with regulations and guidelines. This article provides insight into these issues and how to avoid them.
Targeted Case Management (TCM) is consists of services that assist eligible beneficiaries in securing medical, social, educational and other health services necessary to appropriate care and treatment. Case management is not directly connected with providing the care and services, but instead is a separate and reimbursable type of service under Medicaid that for specific beneficiaries, identifies the appropriate services, assists in locating those services, identifies providers, and monitors the provision of care.