MedTek First

As September closes and Q3 comes to an end, we want to share something directly with every nonprofit organization following this page.

The work you are doing — serving veterans, individuals in recovery, families experiencing homelessness — is among the most important work happening in California. What CalAIM represents is an opportunity to put a sustainable funding structure behind that work, so your organization's ability to serve is not at the mercy of grant cycles or year-end budget gaps.

We started MedTek First because we believe organizations doing life-saving work deserve to be properly compensated for it. That belief has not changed.

As you head into Q4, here is where we can help.

1. If your organization is not yet enrolled as a CalAIM provider, the enrollment process for 2027 service delivery is underway. The time to begin is now, not January.

2. If you are already enrolled but your revenue is not meeting projections, a claims and documentation review will identify where the gap is. Most issues we find are correctable within 60 to 90 days.

3. If you are enrolled and performing well but have not yet assessed expansion into additional Community Supports service lines, Q4 is the right window to plan that growth.

We are available for a no-cost initial consultation for any California nonprofit organization that is seriously considering CalAIM enrollment.

To get started, comment "CalAIM" below or send us a message with the name of your organization and the population you serve. We will be in touch within one business day.

Thank you for following along this month. We look forward to continuing this work with you.

A pattern we have been watching closely: managed care plans across California are increasing the frequency of documentation reviews for Enhanced Care Management providers.

This is not a formal DHCS policy change — it is a shift in how MCPs are operationalizing oversight expectations that have been building throughout 2026.

What it means in practice for California nonprofit ECM providers:

1. Documentation depth matters more than it did. Care coordinators need to record not just what services were delivered, but the clinical or social drivers that made each encounter medically necessary. Generic notes that describe activity without context are the ones getting flagged.

2. Authorization gaps are being caught faster. If your organization has any lapsed or expired authorizations that continued into billing, managed care plans are identifying those more quickly than in prior years. Reviewing your authorization tracking before the end of Q3 is worth the time.

3. Internal audits are now a best practice, not a reactive step. Organizations that are auditing a sample of their own claims monthly are catching issues before they become formal requests. Those that are not auditing are learning about problems from their MCP instead.

None of these items require dramatic operational changes. They require attention and process.

If your organization is concerned about whether your documentation practices meet current MCP expectations, comment "CalAIM" below or send us a message with the name of your managed care plan. We can give you a clear picture of where you stand and what, if anything, needs to be adjusted.

California nonprofit leaders: as the third quarter closes, here is the question worth asking your team.

Is the revenue your organization is generating from CalAIM this year what you projected? And if not, do you know why?

The gap between projected and actual CalAIM reimbursement almost always traces back to one of three areas.

1. Caseload shortfall. If your enrolled caseload is lower than projected, the cause is usually one of two things: slower intake than planned, or members leaving the program before their authorization period ends. Both are addressable with the right intake and retention protocols.

2. Claims leakage. If your caseload is where it should be but reimbursement is below expectations, the issue is typically claims being denied, delayed, or submitted at lower rates than services were actually delivered. A billing audit will identify where the leakage is occurring.

3. Service line gaps. Some organizations are billing for primary service lines but have not yet enrolled for additional Community Supports categories that apply to their clients. Housing deposit support and housing transition navigation, for example, are commonly underutilized reimbursement streams for organizations serving unhoused populations.

All three of these are identifiable and correctable before year-end.

If your organization wants a Q3 revenue performance review before heading into Q4, send us a message. We will walk through your numbers and identify where the opportunities are.

The goal is to enter 2027 with a clear, accurate picture of your CalAIM revenue potential — and a plan to capture it.

An important update for California nonprofits billing MEDI-CAL through CalAIM's Enhanced Care Management program.

DHCS is placing increased emphasis on population health stratification in ECM authorization reviews. What this means in practical terms is that managed care plans are looking more carefully at whether enrolled ECM members genuinely represent the highest-complexity patient populations.

There are three things every CalAIM ECM provider should review in response.

1. Medical necessity documentation. Every ECM enrollment should have clear documentation of the specific conditions, functional limitations, and unmet health needs that justify ECM. Vague language will not hold up under increased scrutiny.

2. Complexity stratification. Are your ECM members your highest-need clients? Organizations that enrolled broadly at launch should conduct a caseload review to ensure their enrolled population aligns with DHCS expectations for the program.

3. Authorization renewal preparation. As managed care plans review enrollments more carefully, organizations with strong initial documentation are in the best position for smooth renewals. This is the time to tighten your records, not after an authorization challenge.

This is a natural evolution of a maturing program. Organizations with strong compliance foundations and documented outcomes have nothing to fear from this increased scrutiny — in fact, it differentiates them from providers who are less rigorous.

If you have questions about how these developments apply to your specific CalAIM operations, send us a message. We are actively helping clients navigate these changes right now.

California nonprofit leaders preparing for CalAIM operations: your EHR system will determine whether your billing runs smoothly or not. Here is what to look for.

Not every electronic health record system is built for the complexity of MEDI-CAL billing under CalAIM. Choosing the wrong platform creates documentation gaps, billing errors, and compliance exposure that are difficult to correct after your organization has gone live.

There are three capabilities that are non-negotiable for CalAIM providers.

1. Multi-claim type support. CalAIM requires billing across ECM, Community Supports, and potentially other service categories — each with different billing codes and claim structures. Your EHR must handle all of these natively, without workarounds or manual adjustments.

2. Authorization management. Every CalAIM service requires prior authorization that expires on a set schedule. An EHR that tracks authorization status and flags renewals prevents the most common and costly billing error in CalAIM.

3. DHCS-compliant documentation templates. Your case managers should not need to memorize documentation requirements. The right EHR guides them through required fields for each service type at the point of documentation.

We partner with RXNT and recommend it for CalAIM operations. We can also facilitate discounted pricing for organizations engaging us for enrollment and billing support.

If your organization is evaluating EHR options before a CalAIM launch, send us a message with your service lines and caseload size. We will give you our honest assessment of which platform fits your situation.

This is one of those decisions that is much easier to get right the first time.

California nonprofit leaders: Q4 planning season has arrived. Here is what CalAIM providers should be reviewing right now.

The final quarter of the year is when proactive organizations separate themselves from reactive ones. There are three specific areas to assess before October.

1. Caseload and revenue alignment. If your Q3 reimbursements were below projection, the cause is almost always one of three things: caseload growth slower than planned, documentation errors creating denials, or authorization gaps. Each has a different fix — and all three are correctable before year-end.

2. Staffing for Q4 growth. CalAIM revenue scales directly with caseload. If your organization plans to grow in Q4, you need qualified case managers in place before you need them. The recruitment and onboarding timeline for ECM staff is typically 60 to 90 days.

3. Service line enrollment completeness. Many CalAIM providers are billing for ECM but have not yet enrolled for Housing Transition Services, Housing Deposit support, or Post-Hospital services. These are additional MEDI-CAL reimbursement streams available to your organization for clients you are already serving.

Q4 is also the time when organizations thinking about beginning CalAIM in 2027 should start the enrollment process. The timeline from initial assessment to first reimbursement is 6 to 9 months.

If your organization wants a Q4 operational review or is ready to begin the CalAIM enrollment process, send us a message. We will respond within one business day with a clear picture of your options.

California nonprofits billing MEDI-CAL through CalAIM: here is how to prepare for a DHCS audit before it happens.

DHCS conducts audits on CalAIM providers — and the organizations that come through them without disruption are the ones that run tight documentation practices every month, not just when an audit notice arrives.

There are four things every CalAIM provider should be doing consistently.

1. Self-audit your client files quarterly. Select 10 random records and verify them against DHCS documentation standards. If an auditor could not locate required information within two minutes of opening a file, the file does not meet standard.

2. Maintain an active authorization tracker. Every CalAIM service requires prior authorization. Expired authorizations that go unnoticed create overpayment liability. A live tracker with renewal dates prevents this entirely.

3. Document staff training. DHCS expects to see evidence that your staff is trained on CalAIM documentation requirements. Training logs, completion records, and sign-offs are what auditors look for. If you cannot produce them quickly, that becomes a finding.

4. Reconcile billing and documentation monthly. Every claim should correspond to a documented service. Gaps identified internally are fixable. Gaps identified in an audit are not.

These practices are not complicated. They are the difference between an organization that handles an audit smoothly and one that receives a corrective action plan.

If your organization wants a second opinion on your current audit readiness, send us a message. We conduct informal documentation reviews for CalAIM providers at no cost.

California homeless shelters and missions: your organization may qualify for MEDI-CAL reimbursement for services you are already providing today.

CalAIM includes a category called Community Supports, specifically designed for the housing-related work that mission-driven organizations deliver every day.

Here is what qualifies.

1. Housing transition navigation — helping clients find and apply for housing, negotiate with landlords, and complete move-in logistics. This is reimbursable even when the client does not successfully secure housing.

2. Housing deposits — security deposits and first month's rent for clients transitioning out of homelessness or institutional care. Funded directly through the CalAIM system at no cost to your organization.

3. Housing tenancy and sustaining services — ongoing case management to help clients maintain stable housing once they have it, including crisis support and connection to community resources.

If your organization is doing this work, you may already meet the service delivery requirements for CalAIM reimbursement. The gap is typically the enrollment and billing infrastructure — not the programs themselves.

We can walk you through what your specific revenue potential looks like based on your current programs and caseload.

Comment "HOUSING" below or send us a message with a description of your housing programs. We will respond within one business day with a clear picture of your CalAIM eligibility.

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One of the most overlooked steps in the CalAIM enrollment process is managed care plan contracting.

California MEDI-CAL is administered through managed care plans — and which plans you need to contract with depends entirely on the counties where your clients live.

This matters for California nonprofits serving veterans and homeless populations for three reasons.

1. DHCS enrollment and managed care plan contracting are separate processes. You can be fully enrolled with DHCS and still be unable to submit claims until your managed care contracts are in place.

2. Each plan has its own credentialing requirements and onboarding timeline. Starting this process early — at the same time as DHCS enrollment — prevents costly delays.

3. Your managed care plan representative becomes one of your most important relationships for the long term. When a claim is disputed or delayed, having a direct contact accelerates resolution significantly.

We manage the managed care contracting process as part of our CalAIM enrollment support. Every client we work with is assigned specific representatives at the relevant managed care plans in their county before they submit their first claim.

If your organization is currently in the DHCS enrollment process and has not yet initiated managed care plan contracting, send us a message with your county and service area. We can tell you exactly which plans apply to your situation.

This is a step where early action saves months of delay.