Community Health Workers Step by Step Process

The member must be active and enrolled in Trillium Community Health Plan. Confirm member eligibility for the month of service through either of the following:

• The provider portal (preferred method). Log in to the secure provider portal, then select Eligibility Verification under Provider Resources.

The member must have a recommendation on file from a physician or other licensed practitioner of the healing arts. A doula may facilitate obtaining recommendation from any licensed practitioner for the member. We will accept either Health Net or DHCS forms below:

• Trillium Recommendation for Community Health Worker Services – CHWP, coming soon (PDF)
• DHCS recommendation form, coming soon (PDF)

Note: The recommendation form includes information for Notice of Action to file a complaint if a provider declines to file a recommendation.

Keep the recommendation form in the member's record.

Follow these steps:

• I am an ECM provider – refer to CHWP workflow - coming soon
• I am not an ECM provider – refer to step 2 of CHWP workflow - coming soon

Doulas will contact members to schedule an appointment.

Doula services include personal support to women and families throughout a woman's pregnancy, childbirth, and postpartum experience. This includes emotional and physical support, provided during pregnancy, labor, birth, and the postpartum period.

Refer to the CS workflow to identify member needs and confirm if they qualify for Community Supports services.

Second recommendation – Additional visits during the postpartum period require a second recommendation. A doula may facilitate obtaining recommendation from any licensed practitioner for the member.

Any documentation format that meets DHCS documentation of services requirements will be accepted.

Providers can bill through claims submission or invoice submission. Note: if you submit claims, you won't have to submit an invoice and vice versa.

Submit claims or invoice forms and supporting information to one of these options:

• Electronic data interchange (EDI) through a clearinghouse or Availity (recommended).
• Submit paper CMS-1500 (version 02/12) form for paper claims. Refer to the Claims Procedures section for more information

Note: All visits are limited to one per day, per member. Only one doula can bill for a visit provided to the same member on the same day, excluding labor and delivery. One prenatal visit or one postpartum visit can be provided on the same day as labor and delivery, stillbirth, abortion or miscarriage support. The prenatal visit or postpartum visit billed on the same calendar day as birth can be billed by a different doula.

The extended three-hour postpartum visits provided after the end of pregnancy do not require the member to meet additional criteria or receive a separate recommendation. The extended postpartum visits are billed in 15-minute increments, up to three hours, up to two visits per pregnancy per individual provided on separate days.

Billing training

To learn more about how to bill for doula services, refer to the Claims and Invoice Guidance training.

Note: The training deck is available after viewing the training video.