To add a new member (client, patient, customer, recipient) to your Pear Suite account first click the Members page from the main navigation menu on the left.  Next, click the  +Add Member button. 

The only required fields are the ones with a red * next to them - typically First Name, Last Name and Phone Number.  However if you are going be generating Medicaid claims on behalf of this member, the following fields will be required to submit a claims:

First Name
Last Name
Phone Number
Date of Birth
Sex
Insurance company
CIN or Subscriber ID
Address

Once entered, click Update at the bottom which will take you to the member's newly created profile.  Expand the next section for next steps.

If you are working with a new member, best practice is to conduct an initial needs assessment, which is optimized to identify the primary Social Determinants of Health (SDoH) for which the member needs help.

1. On the member's profile, locate the Activities section. 
2. Click +Activity
3. Select CHW New Member Screening
4. If you chose to start the activity immediately, click Create and the activity will beging.
5. If you chose to schedule the activity for later, the activity will appear on the member's Activity section with a green arrow to click when you are ready to start.

The New Member Screening activity is a series of 30 questions best done in one sitting. Along the way, if the member indicates they need help on any topic, the Pear Suite platform will automatically populate Goals on the member's profile. There will be more about that in the next section.  

At the end of the activity click the green “Finish” button in the upper right.  At this step, you decide whether this encounter is billable or not. If the member is covered by Medicaid and if the encounter took 30 minutes, then this activity is billable.  Please check the “Mark as billable” box accordingly. 

To learn how to properly complete this module for a billable activity, please expand the section below called “Billing for CHW Services”

Goals are added to the member's profile as a way to track the areas of assistance a member needs and the progress you and the member are making toward that goal.  

There are 2 ways a member goal is added to their profile:

1. Automatically as you are answering questions in the New Member Screening activity. In that screening, if a member answers that they often don't have money to buy food, a Food Assistantace goal is automatically added to their profile, along with action items to check as you work the the member toward that goal. 

2. Manually from the Goals section of the member's profile.  You can click the +Goal link to manually add a goal.  You can select a template from the 20+ goal templates available on your account, or you can create a custom goal by entering a name, description and action items. 

As you work with the member, check off the action items.  You can also edit the goal at any time by clicking Edit under the three dots circled in the example below.

 

Member Notes are notes you add to a member's profile, either directly on the member's profile or while doing an activity.

All notes are visible by all your organization's user from the member's profile.

 

Member Notes are presented chronologically on the member's profile with the ability to sort and filter by keywords, domains or by the activity during which the note was added. 

Member Notes are never deleted, however you can redact a member note, or edit a note which creates a new version. When you edit a note, the new version appears but the previous versions remain available to view.

 

Redacted Member Notes appear with a strikethrough on the text.
 

Note Templates

A note template contains distinctly labeled fields for the user to complete while adding a member note, as opposed to the default “Content” field.  You can create note templates from the Templates page of your account. Here is an example of a note template called “Initial Assessment" which can be used to document Primary Needs, Referrals Made and Next Steps identified during an intake encounter. 
 

Best Practice

For Pear Suite subcontractors, we require a note for each billable activity that documents the assistance provided in that encounter.  You can add that member note during the activity or in summary from the End Activity module. 

 

Community Health Work is a Medicaid benefit available to Medicaid recipients in many states. This is typically billed through the member's insurance company. 

Billing Codes

98960 - CHW provided to an individual
98961 - CHW provided to 2-4 members in a group
98962 - CHW provided to 5-8 members in a group

Diagnosis Codes

These are also referred to as Zcodes. The complete list of diagnosis codes appropriate for CHW billing can be found here https://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z55-Z65

Billing requirements, limits and reimbursement amounts vary per state and can be found using this guide State by State Guide to CHW Reimbursement 

Billing for CHW using Pear Suite's Platform

The steps to generating claims can be found in the Billing & Claims section of this Help Center. 


 

If you are a Pear Suite subcontractor for CHW services in California, here is some additional information you'll need to know.

Billable Health Plans Under Pear Suite's Network

Billing Limits

You are able to bill up to 4 units (2 hours) per day for each individual member.

There is a limit of 12 billable units (6 hours) overall per member. If a member requires extended CHW services beyond the initial 12 units, you can request additional billable hours by submitting a plan of care.  Pear Suite supplies the licensed provider for these requests.  

✅ Instructions for requesting additional CHW billing for a member


Compliance Requirements

Pear Suite requires that all subcontractors meet and maintain these Compliance Requirements. 

Claims Management

Pear Suite is the billing provider for our subcontractors, who are considered the rendering providers.  It's the subcontractor's responsibility to generate claims which are error free and to mark each claim “Ready for Screening”.  Pear Suite will then process the claims, ensuring they are submitted to the health plans in a timely manner.  

Remittance Advice (status updates) will post to each claim as the claim is either approved or denied by the health plans. When claims are reimbursed by the health plans, the funds are routed to Pear Suite then on to your Stripe account.  Detailed information on the claims lifecycle is in the Billing & Claims section. 

Claims Reimbursement

To ensure you receive the funds reimbursed by the health plans, you must link your Pear Suite account to a Stripe account. Here are steps, which can be done by an Admin or Owner.

1. In Pear Suite, go to the Organization page
2. Click on the Manage Plan tab at the top
3. Click on the green Create Payout Account button
4. Follow the steps to create a Stripe account or link to an existing Stripe account.